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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
Q

treatment of hyperthyroidism

A

Antithyroid drugs (course or long-term)

Radioiodine 131I

Surgery (partial, subtotal thyroidectomy

26
Q

name some antithyroid drugs

A

Thionamides- carbimazole, propylthiouracil (PTU), methimazole

27
Q

what do antithyroid drugs do?

A

decrease synthesis of new thyroid hormone

28
Q

what does PTU inhibit ?

A

the conversion from T4 to T3

29
Q

what is the main purpose of antithyroid drugs?

A

Don’t treat underlying cause of hyperthyroidism BUT immune modifying effects are seen and a reduction in antibody titres

30
Q

side effects of thionamides

A

Generally well tolerated
Common side effect:
-rash
Less common:
-arthralgia
-hepatitis
-neuritis
-thrombocytopenia
-vasculitis

31
Q

what is hypothyroidism?

A

thyroid hormone levels abnormally low

32
Q

what are the three types of hypothyroidism?

A

primary
secondary
tertiary

33
Q

describe primary hypothyroidism

A

Absence/ dysfunction of thyroid gland
Most cases due to Hashimoto’s thyroiditis
( most common >99%)

34
Q

describe secondary hypothyroidism

A

Pituitary/ hypothalamic dysfunction

35
Q

causes of primary hypothyroidism in adult

A

-Hashimoto’s thyroiditis
-Thyroidectomy
-Iodine deficiency

36
Q

causes of secondary/ tertiary hypothyroidism in adult

A

Pituitary/hypothalamic disease
Drugs e.g. iodine, lithium, thionamides

37
Q

Causes of hypothyroidism – child

A

Neonatal hypothyroidism
Resistance to thyroid hormone
Isolated TSH deficiency

38
Q

what drugs can cause hypothyroidism?

A

Iodine, inorganic or organic
iodide
iodinated contrast agents
amiodarone
Lithium
Thionamides

39
Q

clinical features of hypothyroidism

A

Weight gain
Fatigue
Dry, rough skin
Menstrual disturbance
Constipation
Cold intolerance

40
Q

investigation for primary hypothyroidism

A

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
Q

investigation for secondary hypothyroidism

A

TSH inappropriately low for reduced T4 / T3
levels

42
Q

what is the treatment for hypothyroidism ?

A

Full replacement of 100µg – titre according to TSH
Requirements vary according to cause e.g. higher doses in thyroid ablation

43
Q

how is treatment monitored for hypothyroidism?

A

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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