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Endocrinology > Thyroid Disorders > Flashcards

Thyroid Disorders Flashcards

1
Q

What can go wrong with the thyroid?

A 
Decreased function - hypo
Increased function - hyper
Enlargement - nodular disease
Inflammation (AutoAb)
Cancer
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2
Q

Most common causes of hypothyroidism?

A

a. Iodine deficiency (most common worldwide)

In Aus:

b. Autoimmune chronic lymphocytic thyroiditis (Hashimoto thyroiditis, atrophic thyroiditis)
c. Congenital: error in synthesis of thyroxine
d. Rx: surgery for hyper in the past
e. Transient: silent thyroiditis including postpartum thyroiditis (rebound hypothyroid phase when thyroid is damaged after inflammation e.g. virus)

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3
Q

Ix of hypothyroidism?

A

TSH: elevated
Free T3: low
Free T4: low
Thyroid Ab (anti-TPO, anti- thyroglobulin)

  • Imaging is not indicated in hypothyroidism
  • Consider a thyroid US only if there is a palpable goitre
  • No need for nuclear scan
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4
Q

Sx of hypothyroidism - appearance

A 
Puffy, pale facies
Dry, brittle hair 
Dry, cool skin
Thickened brittle nails
Myxoedema
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5
Q

Sx of hypothyroidism - energy

A

Cold intolerance
Weight gain
Fatigue

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6
Q

Sx of hypothyroidism - nervous system

A

Headache

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7
Q

Sx of hypothyroidism - cognitive

A

d

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8
Q

Sx of hypothyroidism - Cardiovascular

A

d

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9
Q

Sx of hypothyroidism -

A

d

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10
Q

Sx of hypothyroidism -

A

d

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11
Q

Sx of hypothyroidism -

A

d

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12
Q

What is the difference between primary and secondary hypothyroidism?

A

Primary hypothyroidism - pathology of thyroid itself
(raised TSH, low free T3/T4)
Secondary hypothyroidism - pathology of higher centre (anterior pituitary - low TSH, low free T3, T4)

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13
Q

Rx of hypothyroidism

A

Thyroxine - 75-150mcg/day single dose (if young, healthy, pregnant)

Aim for TSH in low normal range

If patient has IHD or elderly, start with smaller dose at 25 mcg/day

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14
Q

Rx of hypothyroidism

What is the 1/2 life of treatment and how does that affect follow up?

What are the modifying factors of Rx?

A

Thyroxine - 75-150mcg/day single dose (if young, healthy, pregnant)

Half life: 1 week therefore steady state app. 6-8 weeks, only do blood test and adjust thyroxine dose after 6-8 weeks

Aim for TSH in low normal range

Modifying factors:
If patient has IHD or elderly, start with smaller dose at 25 mcg/day

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15
Q

What medications decrease thyroxine absorption?

A

Fe tablets, Ca tablets, antacids, cholestyramine

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16
Q

There is usually no hurry in hypothyrodism Rx except in…?

A

Pregnancy

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17
Q

Ix of hypothyroidism?

A

TSH: elevated
Free T3: low
Free T4: low
Thyroid Ab (anti-TPO, anti- thyroglobulin)

  • Recheck TFTs after 6 weeks (except in pregnancy)
  • Imaging is not indicated in hypothyroidism
  • Consider a thyroid US only if there is a palpable goitre
  • No need for nuclear scan
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18
Q

There is usually no hurry in hypothyrodism Rx except in…?

A

Pregnancy

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19
Q

T/F recheck TFTs later than 6 weeks

A

True - no point checking earlier

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20
Q

T/F adjust Rx earlier than 6 weeks

A

False - half life of thyroxine is 1 week therefore steady state is reached at 6-8 weeks (no point checking before)

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21
Q

T/F it is appropriate to request a nuclear scan in hypothyroidism

22
Q

Sx of hypothyroidism - cognitive

A

Depression

Delayed tendon reflexes

23
Q

Sx of hypothyroidism - Cardiovascular

A

Bradycardia
Pericardial effusion
Decreased exercise tolerance

24
Q

Sx of hypothyroidism - GIT

A

Constipation

Anorexia

25
Q

Sx of hypothyroidism - reproductive

A

irregular and heavy menses

Infertility

26
Q

T/F it is appropriate to request a nuclear scan in hypothyroidism

27
Q

Relationship between pregnancy and hypothyroidism

A

Iodine supplementation should be prescribed routinely in women planning a pregnancy

Maternal TFTs change during pregnancy in response to increased metabolic requirements and presence of fetus

Therefore require trimester specific reference intervals

28
Q

Relationship between pregnancy and hypothyroidism

A

Iodine supplementation should be prescribed routinely in women planning a pregnancy

Maternal TFTs change during pregnancy in response to increased metabolic requirements and presence of fetus (esp. thyrotropic activity of B-hCG results in decrease in TSH in first trimester)

Therefore require trimester specific reference intervals

29
Q

Relationship between pregnancy and hypothyroidism

A

Iodine supplementation should be prescribed routinely in women planning a pregnancy

Maternal TFTs change during pregnancy in response to increased metabolic requirements and presence of fetus (esp. thyrotropic activity of B-hCG results in decrease in TSH in first trimester)

Therefore require trimester specific reference intervals

30
Q

Relationship between pregnancy and hypothyroidism

A

Iodine supplementation should be prescribed routinely in women planning a pregnancy

Maternal TFTs change during pregnancy in response to increased metabolic requirements and presence of fetus (esp. thyrotropic activity of B-hCG results in decrease in TSH in first trimester)

Therefore require trimester specific reference intervals

31
Q

Causes of thyrotoxicosis

A

a. Graves’ disease
b. Toxic nodular goitre (multinodular, solitary adenoma)
c. Iodine - induced
- radiographic contrast
- naturapathic remedies
- amiodarone
d. Factitious (surreptitious thyroxine use) - for weight loss
e. Transient (with thyroiditis)

32
Q

Ix hyperthyroidism

A

a. TSH: Low (usually

33
Q

Sx of hyperthyroidism

A 
Heat intolerance
Loss of weight
Increase appetite
Increase in sweating
Tremor
Anxiety, emotional lability
Loss of hair
increased f of bowel movements
Menstrual irregularity
34
Q

Signs of hyperthyroidism on Px ** finish with Talley xx

A 
Increase HR and rhythm 
Tremore
Skin, nail and hair changes
Thyroid size, consistency, bruit
Usually no cervical LNs
Eyes: redness, irritation (conjunctival), exopthalmos, proptosis, lid lag, double vision
35
Q

In a thyroid nuclear scan, what should the thyroid uptake be compared to?

A

in a normal thyroid nuclear scan, thryoid uptake is similar to salivary gland uptake

36
Q

In a thyroid nuclear scan, what should the thyroid uptake be compared to?

A

in a normal thyroid nuclear scan, thryoid uptake is similar to salivary gland uptake

37
Q

Rx of hyperthyroidism

A
  1. Antithyroid drugs:
    a. Carbimazole
    b. Propylthiouracil (PTU)
  2. Radioactive iodine
  3. Surgery: only if other reasons such as - AFx to Rx, cosmetic, risk of malignancy
38
Q

When do you use carbimazole?

A

used in most cases:
- more effective

except in first trimester: teratogenic

39
Q

When do you use PTU?

A

1st trimester of pregnancy as carbimazole associated with teratogenic effects

Not used as much:
Liver failure

40
Q

When do you use PTU?

A

1st trimester of pregnancy as carbimazole associated with teratogenic effects

Not used as much:
Liver failure

41
Q

AFx of carbimazole and PTU?

A

Carbimazole: rash, prirutis (agranulocytosis - rare)

PTU: agranulocytosis, liver damage

42
Q

When do you use carbimazole?

A
  • used in most cases
  • more effective

except in first trimester: teratogenic

43
Q

Rx of hyperthyroidism

A
  1. Antithyroid drugs:
    a. Carbimazole (CBZ)
    b. Propylthiouracil (PTU)
  2. Radioactive iodine
  3. Surgery: only if other reasons such as - AFx to Rx, cosmetic, risk of malignancy
44
Q

AFx of carbimazole and PTU?

A

Carbimazole: rash, prirutis (agranulocytosis - rare)

PTU: agranulocytosis, liver damage

45
Q

Outline in detail the Rx of Graves’ disease

A
  • Need to treat 12-18 months
  • 10-40mg carbimazole a day
  • Adjust dose over 6 weeks (gradual reduction in doses depending on clinical state)
46
Q

Outline Rx of toxic nodular disease

A

Long term Rx of low doses 5-10mg CBZ/day

47
Q

What is are the contraindications of radioactive iodine Rx?

A
  1. Pregnancy
    2.Eye disease in Graves’
    (two factors worsen exopthalmos - smoking and radioactive iodine)
48
Q

What is are the contraindications of radioactive iodine Rx?

A
  1. Pregnancy
    2.Eye disease in Graves’
    (two factors worsen exopthalmos - smoking and radioactive iodine)
49
Q

T/F ask for anti-thyroid Ab if suspecting Graves’

A

F - anti TSH receptor Ab

50
Q

T/F check TFTs and adjust Rx within the 4-12 week interval

A

T - steady state of Rx is between 4-12 weeks

51
Q

What is subclinical hypothyroidism?

Endocrinology (9 decks)

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