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203: The endocrine system > Thyroid diseases > Flashcards

Thyroid diseases Flashcards

1
Q

4 main Thyroid function tests

A

TSH [most influential]

  • Low= hyperthyroidism, secondary hypothyroidism
  • High= Primary hypothyroidism

FT3

FT4

Thyroid auto-antibodies

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2
Q

Thyroid autoantibodies

A

Used to measure thyroid functioning.

Examples

  • Anti-thyroid peroxidase
  • TSH receptor antibody [TRAB]
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3
Q

TSH receptor antibodies

A

Antibodies directed against the TSH receptor
- Can stimulate or block the receptor

Amount is measured to assess function of the thyroid.

  • Blocking TRAb= hypothyrodism, such as Hashimoto’s
  • Stimulating TRAb= Graves’
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4
Q

Anti-thyroid peroxidase antibody

- Raise antibodies indicate…

A

Antibodies that target thyroid peroxidase

Thyroid peroxidase enzyme facilitates the addition of iodine into thyroglobulin.

Raised antibodies indicate

  • Graves’ disease
  • Hashimoto’s thyroiditis
  • Nodular goitre
  • Thyroid carcinoma
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5
Q

Causes of hyperthyroidism [6]

A

Autoimmune [Graves’ disease]

Toxic multinodular goitre

Thyroiditis

Toxic adenoma

Pregnancy

Drugs [amiodarone]

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6
Q

Hyperthyroidism symptoms [9]

A

High temperature/ Heat intolerance

Increased appetite

Weight loss

Fatigue

Increased sweating, thirst

Diarrhoea

Oligomenorrhea

Agitation, irritability

Palpitations

Hair loss

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7
Q

Hyperthyroidism SIGNS

A

Tremors

Sweaty, moist skin

Goitre with bruit

Tachycardia, AF

Muscle weakness

Visual defects

Ophthalmoplegia [muscle paralysis around the eye]

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8
Q

Graves’ disease

  • Presentation
  • Cause
A

Presentation

  • Most common cause of hyperthyroidism
  • Mainly in women, 30-50 yrs
  • Thyroid eye disease [20%]
  • Goitre with bruit
  • Family history of thyroid/ endocrine disease

Cause

  • Autoimmune
  • TSH receptors are overstimulated in the thyroid [high TSH-receptor antibody].
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9
Q

Investigating Graves’ disease

A

Prevalence of thyroid autoantibodies.

Thyroid uptake scan will show diffuse distribution.

Thyroid function results

  • Low TSH
  • High FT4, FT3
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10
Q

Graves’ disease medical treatment

  • Duration
  • Dosage
  • Prognosis
A

18mons- 2yrs

  • Carbimazole
  • Propylthiouracil

Dosage can start high then get titrated down.
or
Block-replace
- High dose maintained whilst administering thyroxine.

Prognosis

  • 1/3 cured
  • The rest relapse
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11
Q

Radioioidine

  • Indication
  • Administration
  • Risks
A

Radioactive iodine

  • Used to treat hyperthyroidism
  • Kills thyroid cells

Administered orally

Risk

  • Hypothyroidism
  • Close contact with others
  • Contraindicated in thyroid eye disease
  • Pregnancy [4-6 months wait at least]
  • Airport security
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12
Q

Sub-total thyroidectomy

  • Description
  • Risks
A

Surgery that partial removes the thyroid
- Treats hyperthyroidism [Graves]

Requires medical therapy
- Must be euthyroid before surgery

Risks

  • Anaesthetics
  • Neck scar
  • Hypothyroidism [thyroid hormones given life-long]
  • Hypoparathyroidism
  • Vocal cord palsy.
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13
Q

Gestational hyperthyroidism

A

Placental beta-human chorionic gonadotrophin [hCG] is released in the first trimester.

  • hCG has similiar structure to TSH
  • Reduces TSH levels and stimulates thyroid hormone productions

Hyperthyroidism risk increases when

  • Pregnant with twins
  • Has severe hyperemesis
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14
Q

Thyroid eye disease

- Description

A

Autoimmune condition that targets orbital tissue around the eyes
- Especially extra-ocular muscles.

Mainly associated with Graves’ disease
- Confirmatory feature.

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15
Q

Thyroid eye disease

- Presentation [7]

A

Proptosis

  • Protrusion of the eyes
  • Can cause inability to close eyes and lead to ulcerated corneas

Itchy/ dry eyes

Compression of the optic nerve can lead to colour blindness

Inflammation of the conjuctiva

Eyelid retraction

Periorbital oedema

Diplopia

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16
Q

Thyroid eye disease treatment [5]

A

Smoking cessation

Steroids

  • IV methylprednisolone
  • Oral prednisolone

Immunosuppressants

Radiotherapy

Surgery
- Relieve compression

17
Q

Toxic adenoma

  • Description
  • Euthyroidism
  • Treatment
A

Benign tumour of the thyroid that can secrete excess T3
- Causing hyperthyroidism

If euthyroid

  • Cancer must be excluded
  • Fine needle-aspiration biopsy

Treatment

  • Short term medical initially
  • Radioiodine
18
Q

Euthyroid goitre

A

Enlargement of thyroid due to iodine deficiency.

Thyroid enlarges to absorb more iodine.

19
Q

Toxic multi-nodular goitre

  • Presentation
  • Investigation
  • Treatment
A

Presence of multiple adenomas on the thyroid.
- Nodules can secrete excess thyroid hormones causing hyperthyroidism

Investigation will show thyroid uptake scan with patchy appearance.
- Uptake more [darker] in nodules.

Treatment

  • Initially medically, to control symptoms [beta-blockers]
  • Curative= radioiodine.
20
Q

Thyroid storm

  • Description
  • Causes
  • Symptoms
  • Treatment
A

A life-threatening increase in thyroid hormone effects.

Causes:

  • Incomplete hyperthyroidism treatment.
  • Untreated hyperthyroidism

Features:

  • High fever
  • Arrhythmia, tachycardia
  • Vomiting, diarrhoea

Treatment

  • Ionorganic iodine
  • Anti-thyroid drugs [carbimazole, propylthiouracil]
  • Beta blockers
  • IV fluids
21
Q

Triggers of thyroid storm [7]

A

Acute/ severe illness/ infection

Hypoglycaemia

Childbirth

Burns

MI, PE

Surgery

Diabetic ketoacidosis

22
Q

Conditions associated with thyroid disease

  • Autoimmune [5]
  • Syndromes
  • Drugs
A

Other autoimmune conditions

  • T1 diabetes
  • Pernicious anaemia
  • Addison’s disease [hypoadrenalism]
  • Premature ovarian failure
  • Coeliac disease

Syndromes

  • Turner’s
  • Down’s

Drugs

  • Lithium
  • Amiodarone
23
Q

Hypothyroidism

- Symptoms [8]

A

Lethargy

Weight gain [despite no change in diet and physical activity]

Cold intolerance

Constipation

Dry skin

Heavy periods

Hair loss

Puffy face

24
Q

Hypothyroidism

- Signs [8]

A

Periorbital oedema

Flaking skin

Diffuse hair loss

Goitre

Carpel tunnel [compression of the median nerve]

Delayed reflex

Bradycardia

Effusions [severe]

25
Q

Primary hypothyroidism

- Causes

A

Autoimmune
- attack on thyroid gland.

Iodine deficiency

Drugs
- Lithium

Thyroiditis

Congenital

26
Q

Autoimmune primary hypothyroidism

- Description

A

Most common cause of hypothyroidism.

Autoantibodies block TSH receptors
- Also inhibits peroxidase

  • Reduced FT4, FT3, high levels of TSH.
27
Q

Hashimoto’s disease

A

Primary autoimmune hypothyroidism with the presence of goitre
- Contain lymphocytic infiltration

28
Q

Primary myxoedema

A

Autoimmune hypothyroidism without goitre or lymphocytic infiltration.

Caused by accumulation of glycosaminoglycans in interstitial.

Very severe, can lead to death/ coma

29
Q

Thyroiditis

A

Self-limiting thyroid disease characterised by initial hyperthyroidism then hypothyroidism.

Initial hyperthyroidism

  • Lasts 1-2months
  • Does not respond to anti-thyroid drugs
  • Cold isotope scan [uptake reduced]

Longer hypothyroid phase

  • 4-6 months
  • Mostly normal within a year
30
Q

Thyroiditis high risk populations

A

Pregnant/ 1 year post-partum

Tender thyroid

Thyroid on inspection does not fit lab results

Recent hepatitis C treatment with interferon

31
Q

Thyroiditis treatment

A

For initial hyperthyroid phase
- Beta blockers

Hypothyroid phase
- Thyroxine

203: The endocrine system (23 decks)

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