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MBChB IV Endocrinology > Thyroid diseases > Flashcards

Thyroid diseases Flashcards

1
Q

Symptoms of hyperthyroidism

A 
Hyperactivity
Irritability
Dysphoria
Heat intolerance
Sweating
Palpitations
Fatigue
Weakness
Weight loss w/ increased appetite
Diarrhoea
Polyuria
Oligomenorrhoea
Loss of libido
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2
Q

Signs of hyperthyroidism

A 
Tachycardia
Afib
Tremor
Goiter
Warm, moist skin
Proximal mm weakness
Lid retraction
Lid lag
Gynecomastia
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3
Q

Name common causes of hyperthyroidism

A

Grave’s disease
Toxic multinodular goiter
Autonomously functioning nodule

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4
Q

Name rare causes of hyperthyroidism

A 
Thyroiditis
Causes of destruction
Thyrotoxicosis factita
Iodine excess
Struma ovarii
Secondary (TSH, BHCG)
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5
Q

How is Jod-Basedow phenomenon linked to hyperthyroidism?

A

Excess of iodine -> hyperthyroidism

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6
Q

What is Grave’s disease?

A

Autoimmune disorder w/ antibodies against TSH receptor w/ intrinsic activity
F>M

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7
Q

Which disease is responsible for 60-80% of thyrotoxicosis?

A

Grave’s disease

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8
Q

Eye signs of Grave’s disease

A 
NOSPECS
No signs or symptoms
Only signs, no symptoms  (lid lag/retraction)
Soft tissue involvement (periorbital oedema)
Proptosis >22mm 
Extraocular mm involvement (diplopia)
Corneal involvement (keratitis)
Sight loss (optic nn compression)
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9
Q

Which test do you perform to measure proptosis?

A

Hertl’s test

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10
Q

Signs other than eye signs of Grave’s disease

A

Pretibial myxoedema
Thyroid acropachy
Onycholysis
Thyroid enlargement w/ audible bruit

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11
Q

How do you diagnose Grave’s disease?

A

Low TSH, high free T4
Thyroid autoantibodies (TPO, antithyroglobulin)
Anti-TSH receptor antibodies
Nucleur thyroid scintigraphy w/ I123, Te99 - increased uptake of radiomarker

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12
Q

What is the treatment of Grave’s disease?

A 
Reduce TH production
Reduce amount of thyroid tissue
- Antithyroid drugs (propylthiouracil, carbimazole)
- Radioiodine 
- Subtotal thyroidectomy 
Symptomatic treatment
- Propanolol
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13
Q

When is radioiodine contraindicated in Grave’s disease?

A

Severe Grave’s ophthalmopathy

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14
Q

Indications for subtotal thyroidectomy?

A

Relapse after antithyroid therapy
Pregnancy
Young age

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15
Q

What is the pathogenic mechanism of Grave’s disease in hyperthyroidism?

A

TSH receptor stimulating antibody

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16
Q

What is the pathogenic mechanism of toxic multinodular goiter in hyperthyroidism?

A

Autonomous hyperfunction

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17
Q

What is the pathogenic mechanism of follicular adenoma in hyperthyroidism?

A

Autonomous hyperfunction

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18
Q

What is the pathogenic mechanism of pituitary adenoma in hyperthyroidism?

A

TSH hypersecretion

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19
Q

What is the pathogenic mechanism of pituitary insensitivity in hyperthyroidism?

A

Thyroid hormone resistance

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20
Q

What is the pathogenic mechanism of hypothalamic disease in hyperthyroidism?

A

Excess TRH production

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21
Q

What is the pathogenic mechanism of germ cell tumours in hyperthyroidism?

A

HCG stimulation

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22
Q

What is the pathogenic mechanism of struma ovarii in hyperthyroidism?

A

Functioning thyroid elements

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23
Q

What is the pathogenic mechanism of metastatic follicular thyroid carcinoma in hyperthyroidism?

A

Functioning metastases

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24
Q

What is the pathogenic mechanism of lymphocytic thyroiditis in hyperthyroidism?

A

Release of stored hormone

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25
What is the pathogenic mechanism of granulomatous thyroiditis in hyperthyroidism?
Release of stored hormone
26
What is the pathogenic mechanism of Hashimoto's thyroiditis in hyperthyroidism?
Transient release of stored hormone
27
What is the pathogenic mechanism of thyrotoxicosis medicamentosa in hyperthyroidism?
Ingestion of excessive exogenous thyroid hormone
28
What is the pathogenic mechanism of thyrotoxicosis factitia in hyperthyroidism?
Ingestion of excessive exogenous thyroid hormone
29
What is the pathogenic mechanism of amiodarone in hyperthyroidism?
Excess iodine and/or thyroiditis
30
What is the pathogenic mechanism of interferon alpha in hyperthyroidism?
Thyroiditis
31
What is the pathogenic mechanism of interferon alpha in hyperthyroidism?
Thyroiditis
32
Symptomsof hypothyroidism
``` Tiredness Weakness Dry skin Feeling cold Hair loss Difficulty in concentrating Poor memory Constipation Weight gain w/ poor appetite Hoarse voice Menorrhagia Oligo/amenorrhoea Parasthesias Impaired hearing ```
33
Signs of hypothyroidism
``` Dry skin Cool extremities Puffy face, hands + feet Delayed tendon reflex relaxation Carpal tunnel syndrome Bradycardia Diffuse alopecia Serous cavity effusions ```
34
Name causes of hypothyroidism
``` Autoimmune - Hashimoto's atrophic thyroiditis Iatrogenic - I123 treatment - thyroidectomy - external irradiation of neck Drugs - iodine excess - lithium - antithyroid drugs Iodine deficiency Infiltrative thyroid disorders - amyloidosis - sarcoidosis - haemochromatosis - scleroderma ```
35
Name causes of hypothyroidism
``` Autoimmune - Hashimoto's atrophic thyroiditis Iatrogenic - I123 treatment - thyroidectomy - external irradiation of neck Drugs - iodine excess - lithium - antithyroid drugs Iodine deficiency Infiltrative thyroid disorders - amyloidosis - sarcoidosis - haemochromatosis - scleroderma ```
36
Lab investigations of hypothyroidism
``` High TSH, low free T4 Antithyroid antibodies (anti-TPO) Increased S-CK Increased S-Chol Increased S-triglyceride ```
37
What will you see on bloods in hypothyroidism?
Normochromic/macrocytic anemia
38
What will you see on ECG in hypothyroidism?
Bradycardia w/ small QRS complexes
39
Thyroid U/S has a lot of value in investigating hypothyroidism True or false?
False | Only show atrophy
40
Thyroid scintigraphy has a lot of value in investigating hypothyroidism True or false?
False | Only show atrophy
41
Treatment of hypothyroidism?
Levothyroxine - 1.5ug/kg/day if no residual thyroid function - 12.5-25ug/day >60yo esp w/ CAD - 50-100ug/day is pt <60yo w/o cardiac disease
42
What is the dose of levothyroxine adjusted according to?
TSH levels
43
Subclinical hypothyroidism
High TSH, normal free T4
44
When do you treat subclinical hypothyroidism?
``` Any of the following: Antibody + Prev treatment for Grave's Other organ specific AI disease TSH > 10 ```
45
How do you treat subclinical hypothyroidism?
Thyroxine treatment
46
When do you not treat subclinical hypothyroidism
``` None of the following: Antibody + Prev treatment for Grave's Other organ specific AI disease TSH > 10 ```
47
How do you monitor subclinical hypothyroidism?
6-12 monthly TSH measurement
48
What do you do if a patient with subclinical hypothyroidism is symptomatic?
Trial of thyroxine
49
What is euthyroid sick syndrome?
Occurs in patients w/ systemic disease/starvation Decreased peripheral conversion of T4 -> T3 Reduced TSH release Loss of pulsatile secretion Low T3 low T4 low TSH
50
Why should you not bother with TFTs in an ICU patient?
Euthyroid sick syndrome
51
What is acute thyroiditis?
Rare Painful thyroid gland due to suppurative infection of the thyroid Elevated ESR Normal thyroid function
52
Another name for subacute thyroiditis?
De Quervain's thyroiditis | Granulomatous thyroiditis
53
What is the major cause of subacute thyroiditis?
Viral - mumps - coxsackie - influenza - adeno - echo
54
Name causes of acute thyroiditis
``` Bacterial - strep - staph Fungal - aspergillus - candida - histoplasma - pneumocystic Radiation thyroiditis Amiodarone ```
55
What is subacute thyroiditis?
Viral cause 3 phases from painful enlarged thyroid -> complete resolution Affects middle aged women
56
Treatment for subacute thyroiditis?
NSAIDs | Glucocorticoids
57
What is postpartum thyroiditis
``` AKA silent thyroiditis No thyroid tenderness 3-6mo after pregnancy 3 phases: hyper-> hypo -> resolution lasting 12-20 weeks Normal ESR TPO Abs present No treatment necessary ```
58
What is Hashimoto's thyroiditis?
``` Chronic autoimmune Goiter -> destruction of thyroid Insidious onset and progression Pain is rare TPO Abs present ```
59
What is the most common cause of hypothyroidism?
Hashimoto's thyroiditis
60
What is Reidel's chronic thyroiditis?
``` Rare Middle aged women Insidious as painless Symptoms due to compression when dense fibrosis developed No thyroid function impairment ```
61
Which drugs decrease thyroid protein binding concentrations?
Glucocorticoids Androgens Danazol
62
Which drugs increased thyroid protein binding concentrations?
Oestrogens Heroin Clofibrate
63
Give examples of conditions that cause increased thyroid protein binding concentrations?
Pregnancy Chronic hepatitis Acute intermittent porphyria Oestrogen producing proteins
64
Give examples of conditions that cause decreased thyroid protein binding concentrations?
``` Acromegaly Nephrotic syndrome Hypoproteinaemia Liver cirrhosis Testosterone producing tumours ```

MBChB IV Endocrinology (8 decks)

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