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Endocrine > Thyroid Disorders > Flashcards

Thyroid Disorders Flashcards

1
Q

Where is the thyroid gland located?

A

Anterior neck C5-T1
Below the laryngeal prominence (adams apple)
superior to cricoid cartilage

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2
Q

Describe the shape of the thyroid gland and blood supply

A

Butterfly shape 2 lobes- connected in the middle by the isthmus
Superior and inferior thyroid arteries
Superior middle and inferior thyroid veins
Sympathetic innervation

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3
Q

What is the function of thyroid hormones?

A

Metabolic regulation..
incr. rate of
lipogenesis and thermogenesis
gluconeogenesis and glycogenolysis
basal metabolic rate
proteinsynthesis
cardiac output
bone resorption

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4
Q

Which is the more abundant and active form of thyroid hormones?

A

T4 more abundant
T3 active
T4-> T3 at peripheries

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5
Q

How do thyroid hormones travel in circulation?

A

Protein bound as fat soluble
Albumin and thryonine binding globulin

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6
Q

Thyroid hormones belong to which axis?

A

Hypothalamic- pituritary - thyroid axis

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7
Q

What is the difference between hyperthyroidism and thyrotoxicosis?

A

Hyperthyroidism= overactive thyroid gland
Thyrotoxicosis = excessive thryoid hormone in circulation - may be from incorrect thyroid medication than hyperthyroidism

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8
Q

What is hyperthyroidism?

A

Overproduction of thyroid hormone due to thyroid gland over activity

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9
Q

What is primary hyperthyroidism

A

Over production of thyroid hormones due to abnormal overactivity of the thyroid gland - thyroid pathology

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10
Q

What is secondary hyperthyroidism?

A

Over production of thyroid hormones due to over-stimulation of the thyroid gland from TSH
Pathology of hypothalamus or pituitary

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11
Q

Describe the epidemiology of hyperthyroidisim?

A

Women > men
20-40yrs presentation
2.5% women

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12
Q

What are the general signs and symptoms for hyperthyroidism?

A

Symptoms…
- Wt loss, anxiety/ irritability, heat intolerance (hot and sweaty)
- hyperphagia, menstrual disturbances, palpitations

Signs
Tachycardia, tremor, thin hair, hair loss, goitre

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13
Q

What are the general signs and symptoms for hyperthyroidism?

A

Symptoms…
- Wt loss, anxiety/ irritability, heat intolerance (hot and sweaty)
- hyperphagia, menstrual disturbances, palpitations

Signs
Tachycardia, tremor, thin hair, hair loss, goitre

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14
Q

What are the Graves specific signs for hyperthyroidism?

A

Diffuse (smooth) goitre
Grave’s eye disease- exophthalmos- buldging eye due to extraoccular muscle inflam
Pretibital myxoedema- purple/ red symmetrical lesions on anterolater shin

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15
Q

Describe the pathophysiology for Grave’s disease

A
  • Autoimmune condition- IgG serum antibodies
  • TSH receptor antibodies (TRAb) mimic TSH and bind to TSH receptor on thyroid gland
  • Increasing thyroid gland stimulation for excess thyroid hormone production
  • causing smooth goitre, thyroid cell hyperplasia and hyperthryoidism
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16
Q

Describe the aeitology for hyperthyroidism

A

Graves disease (2/3rd cases)
Toxic multinodular goitre
Toxic adenoma
Drug induced - amiodarone

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17
Q

What are the risk factors for hyperthyroidism?

A

Smoking
Women
HLA - DR3
Amiodarone

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18
Q

What is the first line drug therapy for hyperthyroidism, action and 2 side effects?

A

Carbimazole - prevents T4 syntheis
Hypothyroidism and agranulocytosis

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19
Q

What are the 2 regimes for carbimazole?

A

Hyperthyriosism
Block and replace- thyroxine and and carbimaole
Titration

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20
Q

What is the second line drug therapy for hyperthyroidism and its action?

A

Propylthiourcil, prevents the conversion of t4->t3

21
Q

What drug can be given to target thesymptoms of hyperthyroidism?

A

Non-specifc beta blockers eg pronanolol
decr. sympathetic ns activation

22
Q

Despite drug therapy, what are the other treatments for hyperthyroidism?

A

Radioiodine (CI pregnancy and breastfeeding)
Thyroidectomy - partial

23
Q

What is the class of drugs and action for hyperthyroidism

A

Thionamides - prevent thyroid hormone synthesis

24
Q

What are the complications of hyperthyroidism?

A

AF, osteoporosis (thyroid hormones increase bone resorption osteroclast activity incr)

25
Q

What is thyroid crisis?

A

Rapid deterioration of thyrotoxicosis so big increase in T4

26
Q

What are the signs of thyroid crisis?

A

Hyperpyrexia
Tachycardia
Delerium, coma and death

27
Q

What is the treatment of thyroid storm

A

Large dose of carbimazole
propanolol
KI (blocks uptake of iodine into thyroid gland)

28
Q

What are the 3 causes of excess thyroid hormones?

A

Gland hyperfunction
Leakage of preformed hormones
Ingested thyroid hromones

29
Q

What are the investigations and results for hyperthyroidism?

A

Thyroid function test
- Primary = low TSH, high t3/3
- Secondary = high TSH, t3/4

Thyroid antibodies
- TRAb = graves specific
- TPO = all cases

30
Q

What is the most common endocrine disorder?

A

hypothyroidism

31
Q

What is hypothyroidism?

A

Deficiency of thyroid hormones due to reduced production from the thyroid gland

32
Q

What is the difference between primary and secondary (central) hypothyroidism?

A

Primary is reduced thyroid hormone production due to disorder of the thyroid gland - Raised TSH, low t3/4

Secondary is reduced thyroid hormone production due to disorder or pathology of the pituitary gland or hypothalamus- low TSH, t3/4

33
Q

Describe the epidemiology of hypothyroidism

A

More common in womem
2-5% prevelance
primary <95% cases

34
Q

What are the causes of primary hypothyroidism?

A
  • Iodine deficiency
  • Hashimoto’s thyroiditis (common in developed countries)
  • Drugs- antithyroid, amiodarone, lithium
  • Thyroidectomy
35
Q

What are the causes of secondary hypothyroidism?

A

Hypopituitarism
Pit tumour
Surgery
Drugs eg cocaine

36
Q

What are the investigations for hypothyroidism?

A
  • TFT:
    P. High TSH, low T3/4
    S. Low TSH, low T3/4
  • Thyroid antibodies
    TPOAb - hashimotos specific
  • Hyperlipidaemia and hypernatraemia
37
Q

What is the managment for hypothyroidism?

A

Levothyroxine (T4)
- Life-long
- P. titrated for TSH levels to normalise

38
Q

What are the complications of hypothyroidism?

A
  • coronary heart disease and stroke
  • dyslipidaemia
  • p. Incr. risk infertility and miscarriage
39
Q

What are the signs of hypothyroidism?

A

Bradycardia
Reduced reflexes reaction
Ataxia
Dry, thin skin and hair
Yawning/ coma
Cold hand and low temp
Ascites
Round puffy face
Defeated demeanour
Immobile and ileus
Congestive

40
Q

What are the symptoms for hypothyroidism?

A

Wt gain
Cold intolerance
Fatigue
Low mood
Hoarse voice
Muscle cramps and myalgia
Poor memory

41
Q

What are the risk factors for hypothyroidism?

A
  • Fam/ personal history of autoimmune diseases eg addisons, coeliac, vitiligo, t1dm
    -thyroidectomy
  • history iodine def
42
Q

What are the 5 types of thyroid malignancies?

A

Papillary
Follicular
Medullary
Lymphoma
Anaplastic

43
Q

What is the clinical presentation of thyroid malignancies?

A

Dysphagia
Hoarse voise
Nodules; hard, irregular, incr. size`

44
Q

What is the treatment for thyrid malignancies?

A

radioactive iodine
surgery
thyroxine

45
Q

What is the differential diagnosis of thyroid malignancy

A

Goitre

46
Q

What is Hashimotos thyroiditis?

A
  • Autoimmune condition that can cause hypothyroidism
  • anti-TPO antibodies and anti-thyroglobulin antibodies cause thyroid inflam.
  • causes goitre then gland atrophy
47
Q

How may amiodarone cause hypothyroidism?

A

It prevents t4 -> t3 in peripheries
It has cytotoxic effects on thyroid follicular cells

48
Q

How may amiodarone cause hyperthyroidism?

A

High iodine content can cause unregulated thyroid hormone production

Endocrine (7 decks)

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