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endocrine (mine) > thyroid diseases > Flashcards

thyroid diseases Flashcards

1
Q

what are the two categories of thyroid diseases

A

primary

secondary

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2
Q

what is a primary thyroid disease

A

a disease affecting the thyroid disease

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3
Q

what is a secondary thyroid disease, how is it defined

A

hypothalamic or pituitary disease

no thyroid gland pathology

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4
Q

what is primary thyroid disease split into

A

goitre or non-goitrous

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5
Q

what is hypothyroidism

A

any disorder which causes insufficient secretion of thyroid hormones from the thyroid gland

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6
Q

what are the primary goitres causes of hypothyroidism

A 
chronic thyroiditis (most common)
iodine deficiency 
drug-induced
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7
Q

what would be a cause of chronic thyroiditis

A

Hashimoto’s thyroiditis

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8
Q

what drugs cause hypothyroidism

A

amidarone

lithium (anti-psychotics)

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9
Q

what are the primary non-goitrous causes of hypothyroidism

A

atrophic thyroiditis
post cancer treatment
congenital developmental defect

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10
Q

what are the primary self-limiting causes of hypothyroidism

A

withdrawal of anti-thyroid drugs
subacute thyroiditis
post-partum thyroiditis

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11
Q

what are the common symptoms of hypothyroidism

A 
peri-orbital puffiness 
pale, cool skin 
pitting oedema
vitiligo 
cold intolerance
hyperlipidaemia (causing many cardiac issues)
low HR 
decreased appetite 
weight gain 
hyperprolactinaemia
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12
Q

what thyroid hormone levels would you expect in PRIMARY hypothyroidism

A

high TSH

low T3 &T4

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13
Q

what thyroid hormone levels would you expect in SECONDARY hypothyroidism

A

Low or normal TSH
low T3 & T4

(all low)

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14
Q

what auto antibodies are associated with hypothyroidism, what condition do they suggest

A

anti-TPO = autoimmune hypothyroidism

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15
Q

what is the treatment of hypothyroidism

A

levothyroxine
young = 50-100 micrograms daily
old = 25-50 micrograms daily

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16
Q

why are elderly patients started on a lower dose of levothryoxine

A

due to the risk of cardiac ischaemia

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17
Q

what is myxoedema

A

severe hypothyroidism

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18
Q

who is typically affected by myxoedema

A

elderly women with long-standing but unrecognised/untreated hypothyroidism

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19
Q

what are the ECG symptoms of myxoedema

A

heart block
t wave inversion
prolonged QT interval

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20
Q

what are the symptoms of myxoedema

A

unusual ECG
bradycardia
type 2 resp failure
co-existing adrenal failure (10%)

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21
Q

what is the treatment of myxoedema

A 
passively rewarm
cardiac monitoring 
monitor fluid balance
broad spectrum antibiotics
give thyroxine cautiously 
give hydrocortisone until adrenal failure has been ruled out
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22
Q

what is autoimmune hypothyroidism also known as

A

hashimoto’s thyroiditis

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23
Q

what is the most common cause of hypothyroidism in the western world

A

hashimoto’s thyroiditis

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24
Q

what is hashimoto’s thyroiditis

A

gradual failure of thyroid function due to autoimmune destruction of the thyroid gland resulting in reduced thyroid hormone production

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25
Q

what is diagnostic of hashimoto’s thyroiditis

A

positive TPO autoantibodies

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26
Q

when would you treat subclinical hypothyroidism

A

if pregnant

if TSH >10

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27
Q

what is hyperthyroidism

A

overactivity of the thyroid gland which leads to thyrotoxicosis

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28
Q

what is thyrotoxicosis

A

clinical, physiological, and biochemical state arising when the tissues are exposed to excess thyroid hormone

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29
Q

what diseases cause excess thyroid stimulation which leads to hyperthyroidism

A

graves disease
thryoid cancer (rare)
thyroid nodules

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30
Q

what causes thyrotoxicosis without hyperthyroidism

A

thyroiditis

over-treatment with levothyroxine

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31
Q

what are the symptoms of hyperthyroidism

A 
palpitations/ AF
tremor 
sweating 
anxiety/irritable 
frequent, loose stools 
eye problems = graves 
weight loss
increased appetite 
intolerance to heat
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32
Q

what thyroid hormone levels would you expect in PRIMARY hyperthyroidism

A

low TSH

high T3 & T4

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33
Q

what thyroid hormone levels would you expect in SECONDARY hyperthyroidism

A

high or normal TSH
high T3 & T4

(all high)

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34
Q

what is the treatment of hyperthyroidism

A

beta-blocker (propanol)
thyroid suppressant drug
radioiodine
surgery s

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35
Q

what is the first line drug treatment of hyperthyroidism

A

carbimazole

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36
Q

what are the contraindications of carbimazole

A

pregnancy

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37
Q

what is the 2nd line drug treatment of hyperthyroidism

A

propylthiouracil

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38
Q

when is surgery indicated in hyperthyroidism

A

if pressure symptoms are present:

dysphagia, stridor, hoarseness

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39
Q

what are the risk with surgery in the treatment of hyperthyroidism

A

recurrent laryngeal nerve palsy
hypothyroidism
hypoparathyroidism

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40
Q

what is thyroiditis

A

inflammation of the thyroid

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41
Q

what are the common causes of thyroiditis

A 
hashimotos 
post-partum 
drug-induced
acute suppurative thyroiditis 
de Quervain's
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42
Q

what is acute suppurative thyroiditis

A

thyroiditis caused by bacteria

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43
Q

what is De Quervain’s thyroiditis

A

thyroiditis caused by a virus

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44
Q

what are the investigations of acute suppurative thyroiditis, what would it show

A

sctintigraphy scan = low uptake though-out

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45
Q

what are the symptoms of acute suppurative thyroiditis

A

neck tenderness
fever
other viral symptoms

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46
Q

what is the treatment of acute suppurative thyroiditis

A

self-limiting

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47
Q

when is subclinical hyperthyroidism often seen

A

multinodular goitre

48
Q

what is subclinical hyperthyroidism associated with

A

AF

osteoporosis

49
Q

when would you treat subclinical hyperthyroidism

A

if TSH <0.1

if there is co-existing fracture, AF or osteoporosis

50
Q

what is graves disease

A

autoimmune disease causing hyperthyroidism

51
Q

what age range is affected by graves disease

A

20-50

52
Q

what are the SPECIFIC symptoms of graves disease

A

pre-tibial myxoedema
diffuse goitre
thyroid bruits (if goitre is large)
graves eye disease

53
Q

what is the treatment of graves eye disease

A

lubricants, steroids, radiotherapy, surgery (depends on severity)

54
Q

what thyroid hormone levels would you expect in graves disease

A

low TSH

high T3 & T4

55
Q

what other investigations would you do in graves disease

A

hypercalcaemia
high all phos
TSH receptor antibody (TRAb) present
imaging

56
Q

when is imaging unnecessary in graves disease

A

if TRAb is present

57
Q

what is the treatment of graves disease

A

carbimazole
radioiodine
surgery

58
Q

what is the 1st line treatment in relapse of graves disease

A

radioiodine

59
Q

when is radioiodine contraindicated

A

pregnancy

active graves eye disease

60
Q

what is thyroid storm/crisis

A

severe hyperthyroidism

61
Q

who does thyroid crisis usually affect

A

hyperthyroid patients with an acute infection/illness or recent thyroid surgery

62
Q

what are the symptoms of thyroid crisis

A

exaggerated reflexes
hyperthermia
respiratory and cardiac collapse

63
Q

what is the treatment of thyroid crisis

A 
Lugol’s iodine
Glucocorticoids
PTU
Beta-blockers
Fluids
Monitoring
64
Q

what are the types if congenital thyroid disease

A

primary

secondary

65
Q

give examples of primary congenital thyroid disease

A

dysplastic gland +/- abnormal site

error in thyroid hormone metabolism

66
Q

give examples of secondary congenital thyroid disease

A

congenital pituitary disease

hypopituitarism

67
Q

what are the symptoms of congenital thyroid disease

A 
delayed jaundice
poor feeding but normal wight
hypotonia 
    - umbilical hernia
    - constipation
68
Q

what are the investigations of congenital thyroid disease

A

guthrie test
TSH levels
T4 level

69
Q

what can a delay in treatment of congenital thyroid disease cause

A

cretinism

70
Q

why does amidarone cause abnormal thyroid function hormone levels

A

it inhibits DIO1 which increases free T4, decreased T3 and leave TSH at normal levels

71
Q

what does amidarone cause

A

hypothyroidism in iodine rich areas

Hyperthyroidism in iodine deficient areas

72
Q

what is a goitre

A

any enlargement of the thyroid gland

73
Q

what causes a goitre

A

lack of dietary iodine

reduced T3 & T4

74
Q

what are the investigations of a goitre

A

TSH levels

Ultrasound guided FNA

75
Q

when would you do an isotope scan in goitre

A

if TSH is suppressed

76
Q

what does a midline goitre suggest

A

thyroid
thyroglossal cyst
dermoid cyst

77
Q

what are the types of goitres

A

diffuse/solitary

multi-nodular

78
Q

what is the cause of a multi-nodular goitre

A

evolution from a long-standing, simple goitre

variation of response of follicular cells to external stimuli

79
Q

what is the treatment of a goitre

A 
nothing = asymptomatic
radioiodine = significant hyperthyroid issues
surgery = causing structural problems
80
Q

what would make you suspect a thyroglossal cyst

A

moves when tongue is stuck out

81
Q

describe a dermoid cyst

A

soft and non-fluctuant

82
Q

what is the cause of a brachial cyst

A

which arises in the upper part of the anterior triangle.

83
Q

where does a brachial cyst arise

A

upper part of the anterior triangle

84
Q

what is the investigation for brachial cyst

A

FNA for cholesterol crystals

85
Q

what is the description of a brachial cyst

A

half-filled hot water bottle

86
Q

what is the description of cystic hygroma

A

lymph filled and so are Transilluminate

87
Q

what is follicular adenoma

A

discrete solitary mass composed of neoplastic thyroid follicles and encapsulated by a surrounding collagen cuff.

88
Q

what causes thyroid adenoma

A

mutations of TSHR signalling pathway

mutant RAS or PIK3CA

89
Q

what is the most common thyroid malignancy

A

papillary carcinoma

90
Q

how does papillary carcinoma present

A

solitary nodule within the thyroid, may be cackled by psammoma bodies

91
Q

what is the treatment of papillary carcinoma

A

thyroidectomy

92
Q

what is the follow up after treatment of papillary carcinoma

A

TSH 0.4-4 (lower levels of normal are preferred)
check Thyroglobulin
TSH/Tg measured every 6 months for 1st 5 years and then annually for the next 5 years

93
Q

what is the 2nd most common thyroid cancer

A

Follicular Carcinoma

94
Q

at what age does Follicular Carcinoma occur

A

40-50s (later than papillary carcinoma)

95
Q

at what age does papillary cancer arise

A

30-40

96
Q

what is the treatment of Follicular Carcinoma

A

minimally invasive = thyroid lobectomy

significant invasion = total thyroidectomy

97
Q

what is thyroglobulin

A

precursor of T4/T3 made by follicular epithelial cell

98
Q

what is the follow up after the treatment of Follicular Carcinoma

A

TSH 0.4-4 (lower levels of normal are preferred)
check Thyroglobulin
TSH/Tg measured every 6 months for 1st 5 years and then annually for the next 5 years

99
Q

what is the cause of Follicular Carcinoma

A

iodine deficiency

mutation in PI3K (RAS family)

100
Q

what is the cause of papillary carcinoma

A

ionising radiation

activation of MAP kinase pathway

101
Q

what does cells does Medullary Thyroid Carcinoma arise from

A

C cells aka parafollicular cells

102
Q

what cells does follicular carcinoma arise from

A

follicular cells

103
Q

what cells does papillary carcinoma arise from

A

follicular cells

104
Q

what causes Medullary Thyroid Carcinoma in young people

A

MEN2

105
Q

what causes Medullary Thyroid Carcinoma on adults

A

sporadic mutation = solitary nodule

familial medullary carcinoma = bilateral/multi-centric nodule

106
Q

what can be secreted in Medullary Thyroid Carcinoma

A

calcitonin

107
Q

what can secretion of calcitonin in Medullary Thyroid Carcinoma cause

A

amyloid deposition

108
Q

what are the investigations of Medullary Thyroid Carcinoma

A

FNA = amyloid and high calcitonin

24hr urinary metanephrines = MEN2

109
Q

how does hCG impact thyroid hormones

A

causes an increases thyroxine with surpasses TSH

110
Q

what thyroid condition does hCG cause thyroid hormones to mimic

A

hyperthyroidism

111
Q

why is hypothyroidism common in pregnancy

A

plasma protein binding increases causing an increased demand in thyroid hormones

112
Q

what should you do with a pregnant patient who has pre-existing hypothyroidism

A

increased thyroxine dose by 25mcg

check thyroid function test monthly, then twice monthly after 20 weeks

113
Q

what TSH level should be aimed for in a pregnant patient who has pre-existing hypothyroidism

A

TSH <3

114
Q

how can you tell the difference between hyperthyroidism in pregnancy and hyperemesis

A

TRAb antibody is present in 3rd trimester in hyperthyroidism

115
Q

what is the treatment for a pregnant patient who has pre-existing hyperthyroidism

A

treat symptoms if they are on going by 20 weeks

low-dose antithyroid drugs

116
Q

what antithyroid drugs are used to treat a pregnant patient who has pre-existing hyperthyroidism

A

1st trimester = propylthiouracil

2nd/3rd trimester = carbimazole

117
Q

what is postpartum thyroiditis

A

For 1-4 months postpartum, women may become transiently thyrotoxic before experiencing hypothyroidism

endocrine (mine) (12 decks)

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