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MEH > Thyroid Disorders > Flashcards

Thyroid Disorders Flashcards

1
Q

What is the Isthmus of the Thyroid?

A

The bridge which connects the 2 lobes of the thyroid

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2
Q

What is the name of the 2 blood vessels which supply the Thyroid gland with blood and which major blood vessel do they branch from?

A

Superior thyroid artery
Inferior thyroid artery

These 2 arteries branch from the common Carotid arteries

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3
Q

Where is the thyroid cartilage in relation to the Thyroid gland?

A

Superior to the Thyroid

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4
Q

Where is the Thyroid gland located in the body?

A

In the neck anterior to the lower larynx and upper trachea

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5
Q

What is the embryological development of the Thyroid?

A

Originates in Foramen caecum and migrates down the Thyroglossal duct to where it then developed

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6
Q

What is Fascia?

A

Tissue that separates out different organs

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7
Q

What is the name of the Fascia that surrounds the thyroid?

A

Pretracheal fascia

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8
Q

Why does the Thyroid move on swallowing?

A

The pretracheal fascia is connected to a special plane which moves up on swallowing and the Thyroid is found in here

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9
Q

How can you tell if somebody a lump on someone’s neck is on the Thyroid?

A

Get them to swallow
If lump moves = on thyroid
If lump stays = not on thyroid

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10
Q

Generally, what do Thyroid hormones do?

A

Control metabolic rate

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11
Q

What systems of the body are affected by Thyroid disease and what are some symptoms?

A

Affect ALL systems:
Energy
Weight
Temperature
Heart rate
Nervous system
GI system
MSK
Skin

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12
Q

How does Thyroid hormone regulate its own production? Longer explanation (Negative feedback)

A

When Thyroid levels are high it can INHIBIT:
-Anterior Pituitary reducing TSH synthesis
-Hypothalamus inhibiting TRH (Thyrotropin Releasing hormone) which means the Anterior Pituitary does receive stimulation to produce TSH so Thyroid is not simulated

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13
Q

How does Thyroid hormone regulate its own production? (Short explanation)

A

High T4 inhibits Hypothalamus (TRH) and pituitary (TSH)

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14
Q

What does Primary Hypothyroidism cause lack of?

A

Low free T4 (Thyroid hormone)

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15
Q

If free T4 levels are low, the level of what hormone is likely to be high to try and compensate?

A

TSH

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16
Q

What is Primary Hyperthyroidism?

A

Higher than normal levels of free T4

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17
Q

In Hyperthyroidism, If levels of free T4 are high, what are the levels of TSH likely to be like?

A

Low

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18
Q

How do you examine a patients Thyroid?

A

Feel the neck from behind
Should not feel if thyroid is enlarged
Swallow to feel if lump moving

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19
Q

Imaging methods to check the Thyroid are:

A

Ultrasound
Radioisotope scan

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20
Q

What radioisotope is usually used when imaging the Thyroid in a radioisotope scan and why?

A

Iodine
Iodine taken up into Thyroid gland
Thyroxine is made up of iodinated tyrosine

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21
Q

What is a lingual Thyroid and why might it exist?

A

Thyroid tissue up by the tongue
Some of the thyroid remained at the Foreamen caecum and did not migrate fully down the Thyroglossal duct during embroylogical development

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22
Q

What is goitre?

A

Lump or swelling on the front of the neck due to a swollen thyroid

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23
Q

What is a retro sternal goitre?

A

Swollen thyroid gland in the chest behind the sternum can push windpipe to the side

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24
Q

What is myxoedema?

A

Swelling of the skin due to build up of mucus and fluid

25
Q

What are the symptoms of Hypothyroidism?

A

Tiredness
Weight gain
Cold intolerance
Hange in appearance (myxoedema)
Depression
Constipation
Puffy eyes

26
Q

What are the signs of hypothyroidism?

A

Peri-orbital oedema (puffy swelling eyes)
Bradycardia
Cold peripheries
Carpal tunnel syndrome (fluid builds up on median nerve)

27
Q

What causes Hypothyroidism?

A

AUTOIMMUNE
Hashimotos Thyroiditis
Post-partum thyroiditis
Dyshormonogensis (congenital defect of thyroid metabolism)
Medication (Amioderone = slow release iodine)
IODIINE DEFICIENCY (Can’t make Thyroxine)

28
Q

What is Hashimotos Thyroiditis?

A

When autoimmune antibodies target the Thyroid gland causing the gland to become inflamed and swell producing GOITRE

29
Q

Why are landlocked countries likely to have endemic goitres?

A

Lack of iodine in diets

30
Q

How do we treat Hypothyroidism?
Who should we be careful of treating?

A

Provide Lifelong thyroxine (T4)

Be careful providing thyroxine to the elderly and people with heart disease since T4 increases heart rate

31
Q

How can you tell if the dose of T4 being provided to treat Hypothyroidism is working?

A

Symptoms resolve
If TSH is high, need to give more T4
If TSH low need to reduce amount of T4 given

32
Q

What is a Myxoedema coma?

A

Severe Hypothyroidism
Causes Hypothermia and fluid overload in heart pericardial effusion

33
Q

How do we treat the emergency of Myxoedema coma?

A

Rapid IV fluids
Hydrocortisone (Myxoedema coma usually happens alongside an Adrenal crisis)
Gradual Rewarming

34
Q

What is hydrocortisone?

A

A Glucocorticoid steroid drug

35
Q

What is borderline/sub-clinical hypothyroidism?

A

When a patients fT4 levels are normal but on the lower range causing the Anterior pituitary to increase TSH levels

36
Q

Would you normally treat sub clinical/borderline hypothyroidism straight away?

A

Not normally, monitor until symptoms warrant treatment since it usually corrects itself

If woman is planning pregnancy, normally give Thyroxine since it is essential for healthy brain development

37
Q

What is Malaise?

A

General feeling of weakness and illness

38
Q

What are the symptoms of Hyperthyroidism?

A

Weight loss
Irritability
Insomnia
Sweating
Palpitations
Tremor

39
Q

What are the signs of hyperthyroidism?

A

Hyperkinesis
Tachycardia
Hypertension
Atrial fibrillation
Lid lag
Proximal myopathy
Warm peripheries

40
Q

What is hyperkinesis?

A

Cans stop moving

41
Q

What is Proximal myopathy?

A

Symmetrical weakness of Proximal muscle of lower and or upper limbs

42
Q

Why do Goitres caused by Hyperthyroidism have a whooshing sound when listened to?

A

Thyroxine increases blood pressure and decreases peripheral vascular resistance

This increases vascularity so more blood flows through here

43
Q

In Graves’ disease, Why can the eye pop out and the lid retract with hyperthyroidism?

A

The Autoimmuneantibodies that that target the TSH receptors can also attack the fat and muscle in the back of the eye pushing it outwards

44
Q

What is Proptosis?

A

The bulging of one or both eyes out of the normal position

45
Q

Why does lid retraction occur in Hyperthyroidism?

A

Thyroxine increases sympathetic tone
Sympathetic branch of the levator palpabrae superioris stimulated pulling back eyelid

46
Q

What can cause Hyperthyroidism?

A

Graves’ disease
Nodular thyroid disease
Thyroiditis

47
Q

What is type of disease is Graves’ disease?

A

Autoimmune

48
Q

How does Graves’ disease cause Hyperthyroidism?

A

Autoimmune antibodies stimulate the receptors that TSH would normally act on
This stimulates the over production of Thyroxine

49
Q

What is Grave Opthalmopathy?

A

When the eyelids get retracted due to action of the autoantibodies in Graves’ disease

50
Q

What is pretibial Myxoedema?

A

Is a Graves Dermopathy
Where autoantibodies from Graves’ disease get deposited under the skin at the shins

51
Q

What is Thyroid acropachy?

A

Looks like clubbing which is increased deposition around nail beds

52
Q

What is Thyroiditis and what causes the Hyperthyroidism?

A

Inflammation of the Thyroid
Destruction of thyroid cells releases Thyroxine into the blood
Usually as a result of a virus

53
Q

How can we treat hyperthyroidism?

A

Medication
Surgery

54
Q

What medication can be given to treat hyperthyroidism and what are the risks?

A

Carbimazole or Propylthiouracil (PTU)
Carbimazole flattens immune system, causes agranulocytosis = low granulocytes in blood like neutrophils

55
Q

What is Thyroid crisis?

A

Hyper Pyrexia
Tachycardia
Cardiac failure
Liver dysfunction

56
Q

Hyperthyroidism and pregnancy issues

A

Graves’ disease antibodies can be passed to fetus
HCG is similar to TSH so HCG may stimulate the Thyroid to make Thyroxine in pregnant women

57
Q

What are the red flags for thyroid cancer? (Rare)

A

Very young/old patient
Rapid enlargement of lump in neck
Dysphagia = trouble swallowing
Hoarse voice (laryngeal nerve infiltrated)
Family story of thyroid cancer

58
Q

What might you notice on examination if a patient has Thyroid cancer?

A

Cervical lymph nodes swollen
Hard irregular thyroid mass
Lump fixed to surrounding structures

59
Q

To treat a thyroid cancer surgery must be done, what must we be careful of while carrying out the surgery?

A

Avoid damage of the Laryngeal nerve to prevent Laryngeal nerve palsy (causes hoarse voice)

Avoid accidentally removing the parathyroid glands causing hypocalcaemia

MEH (33 decks)

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