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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
what is a thyroid storm
Rapid deterioration of hyperthyroidism
26
who usually presents with a thyroid storm
hyperthyroid patient with an acute infection/illness or recent thyroid surgery
27
symptoms of a thyroid storm
hyperpyrexia, severe tachycardia, extreme restlessness, cardiac failure and liver dysfunction
28
management of a thyroid storm
high dose carbimazole propanolol potassium iodide
29
what is subacute thyroiditis
transient patchy inflammation of the thyroid
30
what can cause De Quervain's thyroiditis
viral infection
31
clinical presentation of De Quervain's thyroiditis
painful diffuse goitre fever/malaise
32
3 main phases of De Quervain's thyroiditis
Thyrotoxicosis Hypothyroidism Return to normal
33
investigations for De Quervain's thyroiditis
thyroid function tests may perform scintigraphy to rule out other causes
34
management of De Quervain's thyroiditis
NSAIDs for pain and b-blockers for relief
35
causes of congenital hypothyroidism (4)
absent or underdeveloped thyroid genetic defect in thyroid hormone synthesis iodine deficiency during pregnancy maternal transmission of antithyroid drugs
36
3 types of acquired hypothyroidism
primary, secondary and tertiary
37
what causes secondary hypothyroidism
pituitary disorders resulting in TSH deficiency
38
what causes of tertiary hypothyroidism
hypothalamic disorders resulting in TRH deficiency
39
causes of goitrous primary hypothyroidism
hashimotos thyroiditis iodine deficiency drug induced
40
causes of non-goitrous primary hypothyroidism
atrophic thyroiditis post-radiotherapy congenital defect
41
what is the most common cause of hypothyroidism
hashimotos thyroiditis
42
thyroid hormones in primary hypothyroidism
high TSH low free T3/T4
43
clinical presentation of hypothyroidism
weight gain fatigue dry skin, coarse hair fluid retention
44
who is more likely to get hashimotos
females
45
characteristic signs of hashimotos
anti-TPO antibodies and Tcell infiltrate and inflammation (microscopically)
46
antibody in hypothyroidism
anti-TPO antibody
47
other abnormalities seen primary hypothyroidism
- Macrocytosis (↑ MCV) - ↑ creatinine kinase - ↑ LDL cholesterol
48
thyroid hormones in secondary hypothyroidism
low or normal TSH low free T3/T4
49
management of hypothyroidism
levothyroxine
50
name a severe complication of hypothyroidism
myxoedema coma
51
who does myxoedema coma usually seen in
elderly women with long standing but frequently unrecognised or untreated hypothyroidism
52
name 2 long term complications of autoimmune hypothyroidism
- Increases risk of developing other auto-immune diseases - Increased risk of developing B-cell NHL in the affected gland
53
what is hashimotos thyroiditis
autoimmune destruction of thyroid tissue
54
genes associated with hashimotos
HLA - DR3 and DR5
55
what is subclinical thyroid disease
abnormal TSH with normal thyroid hormone
56
when is treatment of subclinical hypothyroidism indicated
if TSH >10
57
when is treatment of subclinical hyperthyroidism indicated
TSH <0.1%
58
what is subclinical hyperthyroidism associated with
osteoporosis and atrial fibrillation
59
common causes of benign thyroid nodules
cysts colloid nodule benign follicular adenoma hyperplastic nodule
60
features of a benign thyroid nodule
pain/tenderness soft, smooth, mobile family history
61
what is the most common malignant thyroid nodule
papillary thyroid carcinoma
62
clinical features of a malignant thyroid nodule
firm, hard, immobile dysphagia, dysphonia cervical lymphadenopathy lesion >4 cm
63
how do we know if a lump is related to the thyroid
moves on swallowing
64
investigations of a solitary thyroid nodule
thyroid function tests USS possibly with FNA
65
2 classification systems for thyroid nodules
USS classification FNA Bethesda classification
66
USS classification of thyroid nodules
U2-U5 U2 is benign, U3+ is abnormal so do FNA
67
FNA Bethesda classification
Thy1-5 Thy3-5 is abnormal
68
what is a goitre
any enlargement of the thyroid gland, due to impaired synthesis of thyroid hormone
69
pathophysiology of goitre
Reduced T3/T4 production causes a rise in TSH, stimulating gland enlargement
70
name some causes of a diffuse goitre
physiological (puberty, pregnancy) hashimotos, grave iodine deficiency inflammation
71
multi-nodular goitre
develops from a long-standing simple sporadic goitre
72
what causes multi-nodular goitre
mutations of the TSH signalling pathway
73
clinical presentation of multi-nodular goitre
irregular enlarged thyroid due to nodule formation - feels bumpy
74
investigations for multi-nodular goitre
thyroid function test US - FNA? CT scan thyroid isotope scan
75
management of toxic multi-nodular goitre
carbimazole. radioactive iodine if really bad
76
most common cause of hyperthyroidism in pregnancy
graves disease
77
complications of hyperthyroidism in pregnancy
infertility/amenorrhoea spontaneous miscarriage stillbirth thyroid crisis in labour
78
when does post-partum thyroiditis commonly occur
around 6 weeks
79
management of post-partum thyroiditis
treat symptomatic hypothyroid with thyroxine
80
how long does post-partum hypothyroidism last for
up to 1 year, at which it becomes persistent

endocrine (15 decks)

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