Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endocrine > Thyroid diseases > Flashcards

Thyroid diseases Flashcards

1
Q

What is hyperthyroidism?

A

Refers to overactive thyroid gland, leading to increased thyroid hormone (triiodothyorine T3 and thyroxine T4) production and secretion by the thyroid gland.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is primary hyperthyroidism?

A

Refers to thyroid gland pathology causing excessive thyroid hormones.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What types of primary hyperthyroidism are there?

A

Overt primary hyperthyroidism
Subclinical hyperthyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does overt primary hyperthyroidism?

A

Refers to when TSH is below normal range AND free T4 and free T3 are above the normal range.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does subclinical hyperthyroidism mean?

A

Refers to when TSH is below normal range AND free T4 and free T3 are within the normal range.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is secondary hyperthyroidism?

A

Refers to pathology in the hypothalamus or pituitary.

The pituitary can produce too much TSH (thyroid stimulating hormone), which can act on the thyroid gland to produce excessive thyroid hormones.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Examples of primary causes of hyperthyroidism?

A

Grave’s disease
Toxic adenoma
Toxic multinodular goitre
Medications (e.g. amiodarone)
Thyroiditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Examples of secondary causes of hyperthyroidism?

A

Amiodarone
Lithium
TSH producing pituitary adenoma
Choriocarcinoma (beta-hCG can activate TSH receptors)
Gestational hyperthyroidism
Pituitary resistance to thyroxine (i.e., failure of negative feedback)
Struma ovarii (ectopic thyroid tissue in ovarian tumours)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Risk factors for hyperthyroidism?

A
  • Female
  • Family history -Graves’ disease
  • Smoking
  • Low iodine intake
  • Autoimmune disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is Grave’s disease?

A

Refers to an autoimmune condition where the immune system produces TSH receptor antibodies, which acts on the TSH receptors on the thyroid, causing primary hyperthyroidism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is thyroiditis?

A

Refers to thyroid gland inflammation.

Often causes hyperthyroidism at the beginning, then hypothyroidism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is thyrotoxicosis?

A

Refers to excessive quantity of thyroid hormones circulating in the body due to any cause, including hyperthyroidism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does hyperthyroidism present? Presentation of Grave’s disease?

A

↑ Basal metabolic rate
Heat intolerance
Tachycardia and arrhythmias
Weight loss
Diarrhoea
Sweaty skin
Insomnia and sleep disturbances
Restlessness and tremors
Goitre (depending on cause)

Both hyper- and hypothyroidism can lead to:
- mood changes
- depression, anxiety
- menstrual disturbances

Grave’s disease:
- Exophtalmos (proptosis) (bulging eyes)
- Pretibial myxoedema (Looks discoloured, waxy, oedematous appearance)
- Lid lag
- Thyroid acropachy: Soft tissue swelling in extremities, nail clubbing, and periosteal new bone growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What investigations would you do for hyperthyroidism?

A

FBC
LFTs
Inflammatory markers -ESR and CRP.

TFTs
- raised fT4 (free thyroxine)
- raised FT3 ( free triiodothyronine)
- low TSH

Blood tests for thyroid antibodies
- Thyroid peroxidase antibodies (TPOAbs; if a woman is postpartum and potential diagnosis of postpartum thyroiditis)

  • TSH-receptor antibodies (TRAbs; Grave’s disease)

US of the neck

Radioiodine uptake test
- test measures the thyroid’s ability to take up radioactive iodine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How to manage overt hyperthyroidism?

A

Emergency admission:
- if symptoms suggest serious complication (e.g. thyrotoxic crisis)

Urgent referral to endocrinologist:
- if pituitary or hypothalamic disorder

Endocrinologist referral:
- has a goitre, nodule, or structural change in the thyroid gland
- suspected malignancy (TFTs are usually normal in thyroid cancer)

While awaiting specialist assessment, offer:
- beta blocker (propranolol; relief of symptoms (palpitations, tremor, tachycardia, or anxiety)

  • carbimazole →first-line anti-thyroid drug if BB is not helping or not tolerated. [propylthiouracil preferred in pregnant women or planning pregnancy]
  • Amiodarone or lithium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When is thyroidectomy (surgery) offered?

A

Grave’s disease if compression or malignancy suspects OR if other tx unsuitable.

Toxic multiple or single nodule present and radioactive iodine is unsuitable.

17
Q

How to manage subclinical hyperthyroidism?

A

Urgent referral using suspected cancer pathway:
- has a goitre, nodule, or structural change in the thyroid gland
- suspected malignancy (TFTs are usually normal in thyroid cancer)

Endocrinologist referral:
- If two TSH readings are <0.1 mU/L at least three months apart AND evidence of thyroid disease

18
Q

How is Grave’s orbitopathy managed?

A

Emergency admission or ophthalmologist:
→ if suspected sight-threatening complication such as:
- dysthyroid optic neuropathy
- globe subluxation
- corneal exposure (cornea or sclera is visible when eyes are closed)

Smoking cessation

Use of artificial tears to lubricate the eyes.

Avoid irritation and damage to the eyes.

Elevate the head of the bed to relieve morning eyelid swelling.

19
Q

How is Grave’s disease managed?

A

Propranolol (blocks adrenergic effects)

Carbimazole (antithyroid drug)
- start 40mg
- gradually reduce dose to maintain euthyroid
- 12-18 month tx course
- risk of agranulocytosis

If the above does not work, then:
- Carbimazole 40mg
- Take levothyroxine once the pt is euthyroid
- tx lasts 6-9 months

Radioiodine tx
- used if other tx doesn’t work
- contraindicated in pregnancy, age <16, thyroid eye disease
- majority become hypothyroid and require levothyroxine for following 5 yrs.

20
Q

What is thyroid storm?

A

Refers to a rare life-threatening emergency
caused by untreated or inadequately managed hyperthyroidism.

Can occur following stressful illness, thyroid surgery, or radioactive iodine.

21
Q

How does thyroid storm present?

A

Restlessness
Agitation
High-output heart failure
Severe tachycardia
Fever
Dehydration
Vomiting
Delirium and altered mental status

22
Q

How is thyroid storm managed?

A

Emergency treatment (high mortality)

IV fluids, propranolol, hydrocortisone, oral iodine

Carbimazole or propylthiouracil

Radioactive iodine (I-131); thyroidectomy once patient is euthyroid

23
Q

Complications of hyperthyroidism?

A

Thyroid eye disease
Atrial fibrillation
High-output heart failure
Osteopenia/Osteoporosis
Upper airway obstruction
Thyroid cancer
Thyroid storm

24
Q

What is thyroid neoplastic disease?

A

Refers to papillary carcinoma is the most common thyroid cancer.

25
Q

How does thyroid neoplastic disease present?

A

Enlarging thyroid nodule (painless)
Hoarseness
Difficulty swallowing
‘Cold nodule’ on scan [nodules that collect less radioactive material than the surrounding thyroid tissue are considered “cold”]

26
Q

What investigations would you do for thyroid neoplastic disease?

A
  • TFTs
  • USS
  • FNA (fine needle aspiration)
  • radioactive iodine scan
27
Q

How is thyroid neoplastic disease diagnosed?

A

TFTs are often normal

USS -nodule characteristics

FNA -cytology

Radioactive iodine scan -reveals COLD nodule

28
Q

How is thyroid neoplastic disease managed?

A

Total or partial thyroidectomy +/- iodine-131 ablation

Then LT4 replacement (levothyroxine)

29
Q

How is thyroiditis managed?

A

Aspirin, bedrest, +/- steroids

Steroids are given dependent on each hospital and how unwell the patient is.

Steroids help regulate body’s balance of water and electrolytes by promoting fluid retention.

Monitor thyroid levels -will often become hypothyroid before returning normal within 6 months.

Thyroiditis tends to reoccur and the patient is at increased risk of developing thyroid disease in the future.

30
Q

What are the rules for radioactive iodine tx?

A
  • Women must not be pregnant or breastfeeding and must not get pregnant within 6 months of tx
  • Men must not father children within 4 months of tx
  • Limit contact with people after the dose, particularly children and pregnant women
31
Q

Causes of thyroiditis?

A

De Quervain’s (subacute) thyroiditis
Hashimoto’s thyroiditis
Postpartum thyroiditis
Drug-induced thyroiditis (e.g. amiodarone, interferons, lithium, and cytokines)

32
Q

What is Hashimoto’s thyroiditis?

A

Refers to a transient thyrotoxicosis in acute phase and is common in women.

33
Q

What is De Quervain’s (subacute) thyroiditis?

A

Refers to a transient inflammatory thyroid disease (temporary inflammation of the thyroid gland) that is associated with pain and tenderness of the gland.

Three phases:
- thyrotoxicosis
- hypothyroidism
- return to normal

First phase: painful goitre (lump or swelling at front of the neck due to swollen thyroid), raised ESR and CRP (inflammatory markers), flu-like illness (fever, aches, fatigue), and excessive thyroid hormones.

Self-limiting condition, NSAIDs (help pain and inflammation), beta blockers (hyperthyroidism symptoms), levothyroxine (hypothyroidism symptoms)

34
Q

What is postpartum thyroiditis?

A

Refers to a woman’s thyroid becoming inflamed after giving birth.

Endocrine (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions