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phase 2a > thyroid diseases > Flashcards

thyroid diseases Flashcards

1
Q

define hyperthyroidism

A

excess of thyroid hormones in blood

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2
Q

what are the three mechanisms for increased levels of thyroid hormone?

A
  1. Overproduction of thyroid hormone
  2. Leakage of preformed hormone from thyroid
  3. Ingestion of excess thyroid hormone
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3
Q

what are the causes of hyperthyroidism?

A

Graves’ disease (75-80% of all cases)- MOST COMMON
Toxic multinodular goitre
Toxic adenoma
Congenital hyperthyroidism
Thyroiditis (subacute/silent/postpartum)
Iodine induced

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4
Q

which drugs can cause hyperthyroidism?

A

Iodine
Amiodarone
Lithium ?
Radiocontrast agents

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5
Q

what clinical features are present hyperthyroidism?

A
  • weight loss
    -tachycardia
    -anxiety
    -heat intolerance
  • sweating
  • diarrhoea
  • menstrual disturbance
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6
Q

what are the Graves Disease specific clinical signs?

A

-Diffuse goitre
-Thyroid eye disease (infiltrative)
-Pretibial myxoedema
-Acropachy

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7
Q

what are the MNG specific clinical signs?

A

multinodular goitre

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8
Q

what are the Adenoma specific clinical signs?

A

solitary nodule

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9
Q

what investigations take place to test for hyperthyroidism?

A
  1. Thyroid function tests to confirm biochemical hyperthyroidism
  2. Diagnosis of underlying cause important because treatment varies
  3. Clinical history, physical signs usually sufficient for diagnosis
    4.Supporting investigations –
    thyroid antibodies
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10
Q

what are the predispositions for thyroid disease?

A

Genetic and environmental factors in varying proportion
Being female
Environmental factors e.g. stress, high iodine intake, smoking

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11
Q

describe thyroid associated opthalmopathy

A

Swelling in extraocular muscles

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12
Q

what is thyroid associated opthalmopathy likely due to?

A

to an autoantigen in the extraocular muscle that cross reacts with, or is identical to, a thyroid autoantigen

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13
Q

where is thyroid associated opthalmopathy present in?

A

most Graves’ and some autoimmune hypothyroidism patients

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14
Q

what is found in almost all patients with autoimmune hypothyroidism?

A

Thyroglobulin and thyroid peroxidase (TPO) antibodies

( also present in 75% of graves patients)

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15
Q

what do low levels of Thyroglobulin and thyroid peroxidase (TPO) antibodies indicate?

A

healthy individuals at risk of thyroid or other autoimmune disease

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16
Q

describe the mechanism of thyroid cell destruction

A

cytotoxic (CD8+) T cell-mediated

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17
Q

what causes Graves disease?

A

thyroid stimulating antibodies

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18
Q

name some autoimmune diseases associated with thyroid immunity

A

Type 1 diabetes mellitus
Addison’s disease
Pernicious anaemia
Vitiligo
Alopecia areata
Coeliac disease/ dermatitis herpetiformis
Chronic active hepatitis
Rheumatoid arthritis/ SLE/ Sjogren’s syndrome
Myasthenia gravis (Graves’ disease)

19
Q

what is goitre?

A

palpable and visible thyroid enlargement

20
Q

what causes goitre?

A

variety of causes
- commonly sporadic or autoimmune

21
Q

where is goitre commonly present?

A

in iodine deficient areas

22
Q

describe sporadic non toxic goitre

A

Commonest endocrine disorder
Differentiate benign from malignant
Multinodular, solitary nodule, dominant nodule, diffuse

23
Q

describe thyroid function tests in primary hyperthyroidism

A

increase [free T4], increase[free T3], suppressed TSH in primary hyperthyroidism

24
Q

describe thyroid function tests in secondary hyperthyroidism

A

(In secondary hyperthyroidism increase [free T4], increase [free T3] but inappropriately high TSH)

25
treatment of hyperthyroidism
Antithyroid drugs (course or long-term) Radioiodine 131I Surgery (partial, subtotal thyroidectomy
26
name some antithyroid drugs
Thionamides- carbimazole, propylthiouracil (PTU), methimazole
27
what do antithyroid drugs do?
decrease synthesis of new thyroid hormone
28
what does PTU inhibit ?
the conversion from T4 to T3
29
what is the main purpose of antithyroid drugs?
Don't treat underlying cause of hyperthyroidism BUT immune modifying effects are seen and a reduction in antibody titres
30
side effects of thionamides
Generally well tolerated Common side effect: -rash Less common: -arthralgia -hepatitis -neuritis -thrombocytopenia -vasculitis
31
what is hypothyroidism?
thyroid hormone levels abnormally low
32
what are the three types of hypothyroidism?
primary secondary tertiary
33
describe primary hypothyroidism
Absence/ dysfunction of thyroid gland Most cases due to Hashimoto’s thyroiditis ( most common >99%)
34
describe secondary hypothyroidism
Pituitary/ hypothalamic dysfunction
35
causes of primary hypothyroidism in adult
-Hashimoto’s thyroiditis -Thyroidectomy -Iodine deficiency
36
causes of secondary/ tertiary hypothyroidism in adult
Pituitary/hypothalamic disease Drugs e.g. iodine, lithium, thionamides
37
Causes of hypothyroidism – child
Neonatal hypothyroidism Resistance to thyroid hormone Isolated TSH deficiency
38
what drugs can cause hypothyroidism?
Iodine, inorganic or organic iodide iodinated contrast agents amiodarone Lithium Thionamides
39
clinical features of hypothyroidism
Weight gain Fatigue Dry, rough skin Menstrual disturbance Constipation Cold intolerance
40
investigation for primary hypothyroidism
increase TSH (most sensitive marker) usually decrease [free T4], decrease [free T3] T4/ T3 may be low normal in mild hypothyroidism positive titre of TPO antibodies in Hashimoto’s
41
investigation for secondary hypothyroidism
TSH inappropriately low for reduced T4 / T3 levels
42
what is the treatment for hypothyroidism ?
Full replacement of 100µg – titre according to TSH Requirements vary according to cause e.g. higher doses in thyroid ablation
43
how is treatment monitored for hypothyroidism?
Dose titrated until TSH normalises T4 half-life is long – check levels 6-8 weeks after dose adjustment In secondary/ tertiary hypothyroidism TSH will always be low, T4 is monitored

phase 2a (67 decks)

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