Thyroid diseases Flashcards
What is measured in thyroid function tests?
TSH, FT4, FT3, thyroid autoantibodies
What does a positive autoantibody test indicate and what are the different types of autoantibodies?
autoimmune disease.
destructive – targets thyroid for autoimmune destruction
stimulatory – stimulate TSH receptor
What are signs of severe hypothyroidism?
Puffy and pale face Periorbital oedema Dry flaking skin Diffuse hair loss Bradycardia Carpal tunnel Effusions, eg ascites, pericardial Goitre
What are the causes of primary hypothyroidism?
ACTHDI: Autoimmune hypothyroidism Hypothyroidism after treatment for hyperthyroidism (iatrogenic) Thyroiditis Drugs (e.g. lithium, amiodarone) Congenital hypothyroidism Iodine deficiency (not UK)
How is hypothyroidism investigated?
TSH levels higher than range - primary (lower, secondary).
FT4 lower than range - hypothyroidism.
can check thyroid autoantibodies.
imaging not necessary.
What is the treatment for hypothyroidism?
Start with thyroxine (T4) 100 microgram daily (unless elderly/IHD).
Aim normal FT4 without TSH suppression.
Individual variation: may need fine tuning within reference ranges.
What is chronic autoimmune thyroiditis?
Hashimoto’s disease with goitre and lymphocytic infiltration
What are the signs of thyrotoxicosis?
Tremor, brisk reflexes Warm, moist skin Tachycardia, atrial fibrillation Eye signs Thyroid bruit Muscle weakness
What is thyroid eye disease (TED) and what is it associated with?
Inflammation of all orbital tissues except the eye.
associated with Graves disease.
Increased risk in smokers, autoantibody mediated.
What are the causes of thyrotoxicosis?
GGTTTD: Graves' disease Toxic multinodular goitre Toxic adenoma Thyroiditis Drugs (e.g. amiodarone) Gestational thyrotoxicosis
What are the treatment options for Graves’ disease?
Medical therapy: carbimazole or propylthiouracil
Radioactive iodine
Surgery: sub-total thyroidectomy
Symptom control: β-blockers - propranolol (not if asthmatic)
What is thyroiditis and what is the treatment?
Transient mild thyrotoxicosis.
Always resolves, beta-blockers if required, anti-thyroid drugs will not work.
What are the symptoms of thyroid eye disease?
Mild: itchy / dry eyes, proptosis.
Worrisome: diplopia, loss of colour vision, inflammation of conjunctiva, unable to close eyes fully, ache / pain / tightness in or behind eye.
What is the treatment for a toxic adenoma or toxic multinodular goitre?
Initial treatment: short term medical therapy.
Subsequent curative treatment: radioactive iodine.
What are the treatment options for thyroid eye disease?
Active: encourage smoking cessation, steroids - oral prednisolone, other immunosuppressive agents, radiotherapy.
Burnt out: surgical treatment - orbital decompression, eyelid surgery.
