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endocrine > Thyroid Disorders > Flashcards

Thyroid Disorders Flashcards

1
Q

what is thyrotoxicosis

A

the clinical, physiological, and biochemical state arising when the tissues are exposed to excess thyroid hormone

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2
Q

what is hyperthyroidism

A

over-production of the thyroid hormones, triiodothyronine (T3) and thyroxine (T4), by the thyroid gland

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3
Q

what is the most common cause of hyperthyroidism

A

graves disease

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4
Q

who usually presents with graves disease

A

females 20-40 yrs

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5
Q

mnemonic for the causes of hyperthyroidism

A

GIST
graves disease
inflammation (thyroiditis)
solitary toxic thyroid nodule
toxic multinodular goitre

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6
Q

name 4 causes of thyroditis

A

De Quervain’s thyroiditis
Hashimoto’s thyroiditis
Postpartum thyroiditis
Drug-induced thyroiditis

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7
Q

name a drug that can induce thyroiditis

A

amiodarone

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8
Q

what is hashitoxicosis

A

transient hyperthyroidism caused by inflammation associated with Hashimoto’s thyroiditis

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9
Q

pathophysiology of graves disease

A

anti-TSH receptor antibodies stimulate the thyroid resulting in increased function

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10
Q

state 4 specific signs for graves disease

A

pretibial myxoedema
graves eye disease
diffuse goitre
acropachy

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11
Q

what does thyroid acropachy look like

A

hand swelling and finger clubbing

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12
Q

general symptoms of hyperthyroidism

A

weight loss despite increased appetite
frequent loose bowel movements
sweating and heat intolerance
goitre

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13
Q

hormone levels in primary hyperthyroidism

A

low TSH
high free T3/T4

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14
Q

primary hyperthyroidism

A

the thyroid is behaving abnormally and producing excessive thyroid hormone

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15
Q

secondary hyperthyroidism

A

pituitary gland produces too much thyroid-stimulating hormone, stimulating the thyroid gland to produce excessive thyroid hormones

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16
Q

thyroid hormones in secondary hyperthyroidism

A

high or normal TSH
high free T3/T4

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17
Q

antibody in graves disease

A

TSH receptor antibody

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18
Q

when is a scintiscan used in hyperthyroidism

A

patients who are antibody negative to look for toxic nodular disease

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19
Q

management of hyperthyroidism

A

carbimazole

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20
Q

difference in treatment of hyperthyroidism in pregnancy

A

propylthiouracil (PTU) used in the 1st trimester

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21
Q

first line management of thyrotoxic symtoms

A

propanolol

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22
Q

1st line treatment for relapsed graves and nodular thyroid disease

A

radioiodine

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23
Q

complication of radioiodine

A

High risk of hypothyroidism when used in Graves’ disease

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24
Q

when is a thyroidectomy indicated in hyperthyroidism

A

useful when radioiodine is contraindicated

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25
Q

what is a thyroid storm

A

Rapid deterioration of hyperthyroidism

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26
Q

who usually presents with a thyroid storm

A

hyperthyroid patient with an acute infection/illness or recent thyroid surgery

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27
Q

symptoms of a thyroid storm

A

hyperpyrexia, severe tachycardia, extreme restlessness, cardiac failure and liver dysfunction

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28
Q

management of a thyroid storm

A

high dose carbimazole
propanolol
potassium iodide

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29
Q

what is subacute thyroiditis

A

transient patchy inflammation of the thyroid

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30
Q

what can cause De Quervain’s thyroiditis

A

viral infection

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31
Q

clinical presentation of De Quervain’s thyroiditis

A

painful diffuse goitre
fever/malaise

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32
Q

3 main phases of De Quervain’s thyroiditis

A

Thyrotoxicosis
Hypothyroidism
Return to normal

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33
Q

investigations for De Quervain’s thyroiditis

A

thyroid function tests
may perform scintigraphy to rule out other causes

34
Q

management of De Quervain’s thyroiditis

A

NSAIDs for pain and b-blockers for relief

35
Q

causes of congenital hypothyroidism (4)

A

absent or underdeveloped thyroid
genetic defect in thyroid hormone synthesis
iodine deficiency during pregnancy
maternal transmission of antithyroid drugs

36
Q

3 types of acquired hypothyroidism

A

primary, secondary and tertiary

37
Q

what causes secondary hypothyroidism

A

pituitary disorders resulting in TSH deficiency

38
Q

what causes of tertiary hypothyroidism

A

hypothalamic disorders resulting in TRH deficiency

39
Q

causes of goitrous primary hypothyroidism

A

hashimotos thyroiditis
iodine deficiency
drug induced

40
Q

causes of non-goitrous primary hypothyroidism

A

atrophic thyroiditis
post-radiotherapy
congenital defect

41
Q

what is the most common cause of hypothyroidism

A

hashimotos thyroiditis

42
Q

thyroid hormones in primary hypothyroidism

A

high TSH
low free T3/T4

43
Q

clinical presentation of hypothyroidism

A

weight gain
fatigue
dry skin, coarse hair
fluid retention

44
Q

who is more likely to get hashimotos

A

females

45
Q

characteristic signs of hashimotos

A

anti-TPO antibodies and Tcell infiltrate and inflammation (microscopically)

46
Q

antibody in hypothyroidism

A

anti-TPO antibody

47
Q

other abnormalities seen primary hypothyroidism

A
  • Macrocytosis (↑ MCV)
  • ↑ creatinine kinase
  • ↑ LDL cholesterol
48
Q

thyroid hormones in secondary hypothyroidism

A

low or normal TSH
low free T3/T4

49
Q

management of hypothyroidism

A

levothyroxine

50
Q

name a severe complication of hypothyroidism

A

myxoedema coma

51
Q

who does myxoedema coma usually seen in

A

elderly women with long standing but frequently unrecognised or untreated hypothyroidism

52
Q

name 2 long term complications of autoimmune hypothyroidism

A
  • Increases risk of developing other auto-immune diseases
  • Increased risk of developing B-cell NHL in the affected gland
53
Q

what is hashimotos thyroiditis

A

autoimmune destruction of thyroid tissue

54
Q

genes associated with hashimotos

A

HLA - DR3 and DR5

55
Q

what is subclinical thyroid disease

A

abnormal TSH with normal thyroid hormone

56
Q

when is treatment of subclinical hypothyroidism indicated

A

if TSH >10

57
Q

when is treatment of subclinical hyperthyroidism indicated

A

TSH <0.1%

58
Q

what is subclinical hyperthyroidism associated with

A

osteoporosis and atrial fibrillation

59
Q

common causes of benign thyroid nodules

A

cysts
colloid nodule
benign follicular adenoma
hyperplastic nodule

60
Q

features of a benign thyroid nodule

A

pain/tenderness
soft, smooth, mobile
family history

61
Q

what is the most common malignant thyroid nodule

A

papillary thyroid carcinoma

62
Q

clinical features of a malignant thyroid nodule

A

firm, hard, immobile
dysphagia, dysphonia
cervical lymphadenopathy
lesion >4 cm

63
Q

how do we know if a lump is related to the thyroid

A

moves on swallowing

64
Q

investigations of a solitary thyroid nodule

A

thyroid function tests
USS possibly with FNA

65
Q

2 classification systems for thyroid nodules

A

USS classification
FNA Bethesda classification

66
Q

USS classification of thyroid nodules

A

U2-U5
U2 is benign, U3+ is abnormal so do FNA

67
Q

FNA Bethesda classification

A

Thy1-5
Thy3-5 is abnormal

68
Q

what is a goitre

A

any enlargement of the thyroid gland, due to impaired synthesis of thyroid hormone

69
Q

pathophysiology of goitre

A

Reduced T3/T4 production causes a rise in TSH, stimulating gland enlargement

70
Q

name some causes of a diffuse goitre

A

physiological (puberty, pregnancy)
hashimotos, grave
iodine deficiency
inflammation

71
Q

multi-nodular goitre

A

develops from a long-standing simple sporadic goitre

72
Q

what causes multi-nodular goitre

A

mutations of the TSH signalling pathway

73
Q

clinical presentation of multi-nodular goitre

A

irregular enlarged thyroid due to nodule formation - feels bumpy

74
Q

investigations for multi-nodular goitre

A

thyroid function test
US - FNA?
CT scan
thyroid isotope scan

75
Q

management of toxic multi-nodular goitre

A

carbimazole. radioactive iodine if really bad

76
Q

most common cause of hyperthyroidism in pregnancy

A

graves disease

77
Q

complications of hyperthyroidism in pregnancy

A

infertility/amenorrhoea
spontaneous miscarriage
stillbirth
thyroid crisis in labour

78
Q

when does post-partum thyroiditis commonly occur

A

around 6 weeks

79
Q

management of post-partum thyroiditis

A

treat symptomatic hypothyroid with thyroxine

80
Q

how long does post-partum hypothyroidism last for

A

up to 1 year, at which it becomes persistent

endocrine (15 decks)

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