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SYSTEMS - Endocrine > Thyroid Disorders 2 > Flashcards

Thyroid Disorders 2 Flashcards

1
Q

`How does hypothyroidism present?

A
  • Weight Gain
  • Cold intolerance
  • Brittle nails, thin/dry skin & hair
  • Hyporeflexia, slow speech
  • Lethargy & low mood
  • Constipation
  • Bradycardia
  • Heavy periods

Severe cases can cause puffy face, large tongue, hoarseness and coma

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2
Q

How does hyperthyroidism present?

A
  • Weight loss
  • Heat intolerance
  • Muscle weakness
  • Hyperreflexia
  • Frequent bowel movements
  • Palpitations
  • Light periods
  • Sweaty palms
  • Thyroid eye symptoms (bulging)
  • Anxiety/irritibility
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3
Q

How does gender affect thyroid disease?

A

Both hyper and hypothyroidism are much more common in women

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4
Q

What are the types of Hypothyroidism?

A

Primary
Subclinical
Secondary

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5
Q

What causes congenital Hypothyroidism?

A
  • developmental problems e.g. agenesis

- Dyshormogenensis (autosomal recessive condition preventing TH production)

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6
Q

What causes acquired Primary Hypothyroidism?

A
  • Autoimmune (hashimoto’s) thyroiditis
  • Iatrogenic
  • Chronic Iodine Deficiency
  • Post-subacute thyroiditis
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7
Q

What can cause secondary or tertiary hypothyroidism?

A
  • Pituitary tumours
  • Craniopharyngioma
  • Pituitary surgery/radiotherapy
  • Sheehan’s Syndrome
  • Isolated TRH deficiency
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8
Q

What is Sheehan’s Syndrome?

A

Post-partum ischaemic necrosis of the pituitary due to blood loss/hypovolaemic shock of childbirth

Its a potential cause of secondary hypothyroidism

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9
Q

List some iatrogenic causes of primary hypothyroidism?

A

Post op
Radioactive Iodine or Anti-Thyroids
Amiodarone (Sub-acute thyroiditis)
RT for H/N cancer

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10
Q

What tests would you run for suspected hypothyroidism?

A
  • TFTs i.e. TSH & fT4
  • Thyroid Peroxidase Antibodies
  • FBC
  • Lipids
  • Serum Na+
  • Muscle enzymes, ALT & CK
  • Prolactin
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11
Q

Explain why youd do each test for hypothyroidism?

A

FBC - Raised MCV (RBC size)
Lipids - Hypercholesterolaemia
Na+ - Hyponatremia due to excess ADH from hypothyroidism
Muscle enzymes, ALT & CK are all raised
Prolactin - Hyperprolactinaemia

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12
Q

How will TFT’s Appear for each class of Hypothyridism?

A

Primary - Low fT4 but high TSH
Secondary - Low fT4 & low or normal TSH
Subclinical - Normal fT4 & High TSH

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13
Q

What do we use to manage hypothyroidism?

A

Levothyroxine (T4) tablets

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14
Q

Explain the dosing of Levothyroxine?

A

Start at 50mcg/day
Titrate up to 100mcg/day after 2 weeks
Keep increasing until their TSH (primary disease) or fT4 (Secondary Disease) is normal.

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15
Q

What special cases affect how you use Levothyroxine?

A
  • IHD needs to be started lower and titrated slowly as it can trigger Angina
  • Pregnant women need more T4
  • Myxedema Coma needs IV T3
  • Post-partum Thyroiditis needs to have the meds removed for 6 weeks and TFTs measured to see when it abates
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16
Q

Should we treat subclinical hypothyroidism?

A

Only if:

  • TSH >10
  • > 5 + Antibodies
  • TSH elevated + symptoms (temporary trial therapy for symptom improvement)
  • Pregnant or planning pregnancy
17
Q

What are the risks of levothyroxine?

A
  • Thyrotoxicosis
  • AF
  • Osteopenia
18
Q

How does Goitre occur in hypothyroidism?

A

No fT4
No -ve feedback
Excess TSH
Hyperstimulation -> Hyperplasia of Thyroid gland

19
Q

What are the causes for PRimary hyperthyroidism?

A

Graves Disease - 70%
Toxic Multinodular Goitre - 20%
Thyroid Adenoma
Subacute Thyroiditis

20
Q

What is Grave’s Disease?

A

Autoimmune condition in which TSH receptor antibodies continuously stimulate the thyroid causing PRimary hyperthyroidism

21
Q

What is Toxic Multinodular goitre?

A

Multinodular Goitre producing excess thyroid hormones

22
Q

Whats the main cause of secondary hyperthyroidism?

A

Pituitary Adenoma producing TSH

23
Q

What is Thyrotoxicosis without hyperthyroidism?

A

Where you get excess thyroid hormone without hyperthyroidism.

Due to exogenous thyroxine or destructive thyroiditis causing stores of thyroid hormones to be released

24
Q

What causes destructive thyroiditis?

A

Post-partum
Amiodarone induced

Most common causes

25
Q

How do you diagnose Hyperthyroidism?

A

Based on the presentation and TFTs

Can do TSH receptor antibody test for Grave’s Specifically

26
Q

Describe how hyperthyroidism TFTs appear?

A

Primary - High fT4 & low TSH

Secondary - High fT4 & High TSH

Subclinical - Normal fT4 & low TSH

27
Q

How is Hyperthyroidism treated?

A

1st) Anti-thyroid Drugs (ATDs)
2nd) Radioiodine

Resection of thyroid or pituitary adenoma

28
Q

How are anti-thyroid drugs used?

A

Carbimazole or Propylthiourcil

A titration regimen for 12-18 months then move on to radioiodine if uncured

29
Q

How is Radioiodine used?

A

For hyperthyroidism

USed after ATDs fail

High dose ablative regimen cures 90% of patients but leaves 70% hypothyroid

30
Q

When would we treat Subclinical hyperthyroidism?

A

If:

  • Elderly
  • Persistant subclinical hyperthyroidism
  • High cardiac risk patient
31
Q

Risks of Hyperthyroidism treatments?

A

ATDs can cause a rash and agranulocytosis which is a rare and potentially fatal complication

Radioiodine makes ~70% of patients hypothyroid and can cause eye disease

32
Q

What are the types of hyperparathyroidism?

A

Primary - sporadic or familial (MEN-1)

Secondary - Physiological response to low Ca2+ resorption due to kidney failure

Almost all primarys are due to adenomas, some hyperplasia and rarely carcinoma

33
Q

How would you investigate a goitre?

A
  • TFTs
  • Isotope scabn
  • US
  • FNA
  • CXR for retrosternal extension

IF you suspect cancer a serum calcitonin to rule out MEdullary Thyroid Cancer

34
Q

What are the main types of thyroid cancer?

A

Vast bulk are differentiated Thyroid Carcinomas, either papillary or follicular.

Also Anaplastic, Lymphoma and medullary thyroid cancer.

35
Q

How do Differentiated Thyroid Carcinomas spread?

A

Papillary carcinomas spread to local lymph nodes

Follicular Carcinomas metastasise to lung/blood/bone

36
Q

What is medullary thyroid cancer?

A

Cancer of C cells in the thyroid gland
Produces calcitonin
Associated with MEN 2

37
Q

Treatments for Thyroid cancers?

A

High Dose radioiodine
Long-Term levothyroxine to suppress the tumour

Lymphoma - External RT/chemo

Anaplastic - Can be delayed with external RT

Thyroidectomy - Only treatment that works on medullary thyroid cancer

38
Q

When would we stop Levothyroxine for Thyroid cancer?

A

Withdraw from the thyroxine for 2 weeks as a trial and do a full body radioisotope scan to see if its all gone

SYSTEMS - Endocrine (26 decks)

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