Thyroid disorders Flashcards by Maryam Mahmood

parathyroid hormone role in response to low calcium

Decrease renal calcium excretion
increases bone resorption
Enhancing dietary calcium absorption by stimulating the production of calcitriol

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why is parathyroid hormone important in relation to ca2+

functioning of nerves and muscles
To avoid cardiac dysrhythmias

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Hypoparathyroidism syndromes

Di George
HDR

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Causes of hypoparathyroidism

Surgical
Radiation
Syndromes
Autoimmune
Infiltration
Genetic

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What is pseudoparathyroidism

Resistance to parathyroid hormone

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What is hypoparathyroidism

Rare but when the parathyroid gland does not produce enough PTH

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Symptoms of hypercalcaemia

Thirst
Polyuria
Constipation

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Consequences of hyperparathyroidism

Osteoporosis
Kidney stones
Psychic groans
Abdom moans

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define hyperthryoidsm

excess of thyroid hormones in blood ie T3 and T4

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Pathophysiollgy for hyperthyroidism

high T3 /T4 low TSH levels

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3 mechanisms for increased levels of thryoid

. overproduction thyroid hormone
b. leakage of preformed hormone from
thyroid
c. ingestion of excess thyroid hormon

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common cause of hyperthyroidism

graves disease
toxic multinodular goitre
toxic adenoma- one nodule

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what thyroid issue tends to occur after an infection

subacute thyroiditis

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drug induced mechanisms of hyperthyroidism

iodine
amiodarone
lithium
radiocontrast agents

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universal clinical features of hyperthyroidism

Weight loss
tachycardia
anxiety
tremor
diarrohoea

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what does exopthalmos describe

the bulging the eyeball in thyroid disease

due to inflammation, swelling and hypertrophy of the tissue

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what does pretibial myxoedema describe

deposits of mucin under the skin , discoloured waxy oedematous

normally on legs - specific to graves

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what is pretibial myxoedema caused by

reaction of tissue to TSH antibodies

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signs of graves disease

diffuse goitre
thyroid eye disease
pretibial myxoedema
acropachy

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pathophysiology of graves disease

IgG autoantibodies bind to TSH receptors to increase T4/T3 production

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investigations for graves disease

-thyroid function tests
TPO-Ab

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treatment for graves disease

1 carbamizole
2 propylthiouracil
Radioactive iodine
Surgery

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what would patients with toxic multinodular goitre look like

the neck would be swollen and firm
above 50

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define de quervans thyroiditis

subacute granulmatous thyroiditis is a self limited inflammation of the thyroid gland
rapid swelling of the thyroid gland resulting in pain and discomfort

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what is de quervans thyroiditis usually caused by

a viral infection

what would a patient with de quervans show

fever neck pain dysphagia Goitre with nodules

treatment for de quervans thyroiditis

hyper thyroid phase- NSAIDS and corticosteroids hypothyroid phase- normally no treatment

four types of thyroid cancer that cause 98% of thyroid cancers

papillary, follicular, anaplastic, medullary

causes of thyroid cancer

genetic alteration and mutations

presentation of thyroid cancer

palpable thyroid nodule

first line investigation and treatment for thyroid cancer

1st line- ULtrasound scan of neck treatment- thyroidectomy, followed by radioactive iodine ablation and suppression of TSH

investigations of hyperthyroidism

-1st line= thryoid function tests to comfirm biochemical hyperthyroidism - clinical history , physical signs usually enough

eye symptoms of hyperthyroidism

eyelids retracted eye bulging swelling below eyebrow

why does thyroid associated opthamology complications occur

swelling on extraocular muscle

what does the thryoid function test indicate

primary would show increase T4 and supressed tsh AND increase free T3 secondary would show increase free T4 but inappropriately high TSH

TREATMENT FOR hyperthyroidism

depeds on cause = propranalol- used at time of diagnosis to control thyrotoxic symptoms CARBIMAZOLE= blocks thyroid peroxidase > reduces thyroid levels Propylthiouracil -radioiodine -surgery

examples of antithyroid medications

carbimazole to suppress the production of TSH

What med is better for young/ pregnant women

proplythiouracil

side effects of thionamkdes

- rash less common: arthralgia hepatitis neuritis vasculitis

most serious side effect of thionamkikdes

agranulocytosis - presents as sore throat fever and mouth ulcers must warn patients of this stop is this ccurs and do a FBC

HOW does radioidone work as a treatment

Emission of beta particles results in ionization of thyroid cells Direct damage to DNA and enzymes

what is hypothyroidism

thryoid levels abnormally low which results in a generalised slowing of metabolic processes

cause of primary hypothyroidism

thyroglobulin and thyroid peroxidase antibodies present at low levels

pathophysiology of hypothyroidism

T3/T4 not produced, compensatory levels of TSH T3/T4 decrease TSH increase

most common disease associated with primary hypothyroidism

hashimito thyroiditis

what causes secondary hypothyroidism

pituitary failure - not enough TSH

3 types of hypothyroidism

primary, secondary, tertiary

risk factors for hyperthyroidism

smoking stress HLA- DR3 Addisons vitiligo

primary causes of hypothyroidism

hashimoto drugs thyroid resistance iodine deficiency

causes of hypo in child/ neonate

thyroid agenesis thyroid ectopia

investigation for hypothyroidism

thyroid function tests , look at TSH and T4 levels

clinical features of hypothryoidsm

fatigue Goitre non firm but tender cold intolerance menstrual disturbance muscle cramos slow cerebration dry rough skin

define hashimito

aut6oimmune disease in which the thyroid gland is attacked by a variety of cell and antibody -mediated immune processes

cause of hashimoto

autoimmune

pathophysiology of hashimitos

thyroid cells are destroyed via antibody-mediated immune processes formation of antithyroid antibodies that attack the thyroid tissue , causing progressive fibrosis

treatment for hypothyroidism

levothyroxine

what would investigation show for 2/3 hypothyroidism

TSH inappropriately low for reduced T4/T3

TREATMENT of hypothyroidism

synthetic T4 LEVOTHYROXINE

Raised TSH and low t4 would indicate

Primary hypothyroid

Low t4 with normal or low tsh would indicate

Hypothyroidism

Suppressed tsh and high t4 would indicate

Graves’ disease

High t4 and normal or high tsh would indicate

Tshoma

Low testosterone and raised LH and FSH would indicate

Primary hypoglnadism

Low testosterone and normal or low lh / fsh would indicate

Hypopituitary

Low testosterone and suppressed LH would indicate

Anabolic use

Hormone levels before puberty

Oestradiol very low / undetectable Low lh and fsh but fsh slightly higher

Hormone levels around puberty F

Pulsatile LH increases and oestradiol increases

What would primary ovarian failure show

High lh and fsh with fsh greater than lh no oestradial

goitre along with heat intolerance, menstrual irregularity, and tachycardia is suggestive of

hyperthyroidism