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Thyroid Disorders Flashcards

(53 cards)

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1
Q

Where are t4/t3 produced?

A

All of T4 is produced in the thyroid
20% of t3 is secreted, the rest is from peripheral conversion of T4

T3 is active form, vital for growth and development

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2
Q

How is T4 converted to T3 and what happens when this doesnt work?

A

Monodeiodinisation be deiodinase enzymes (d1-3)

Deficiency in these enzymes causes high TSH, high T4 and low T3

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3
Q

What proteins bind thyroid hormones?

A

TBG, TBPA, albumin

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4
Q

What tests can you do for thyroid function?

A

-Serum TSH, freee t3 and free t4

Anti TPO Ab
Anti TSHR ab
USS thyroid to see if lesion is cystic/solid
Radioactive iodine uptake scan (i123)
CXR head and neck (retrosternal goitre, compression)
Serum thyroglobulin- useful in monitorring Ca

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5
Q

What would radionuclide uptake scans show in different causes?

A

Graves disease shows even uptake
Toxic nodular goitre shows patchy uptake
Thyroiditiss shows reduced uptake
cold nodules have a 20%chance of being malignant

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6
Q

What would TFTs show in sick euthyroid?

A

everything is low

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7
Q

Where do you see sick euthyroid syndrome?

A

Starvation states, severe illness requiring ITU, renal failure, cardiac/liver failure

Dont need to give thyroxine

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8
Q

What is struma ovarii?

A

Ovarian teratoma with hyper functioning thyroid tissue. No thyroid enlargement, decresed uptake on scintigraphy

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9
Q

How does TSH vary in the day?

A

trough at around 2, can be around 30% higher in darkness. Monitoring should always be done at the same time of day

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10
Q

How is TBG affected by other processes/drugs?

A

Increased in: Pregnancy, Pill/HRT, hepatitis

Decreased in: nephrotic syndrome, malnutrition, androgens, steroids, chronic liver disease, phenytoin, acromegaly

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11
Q

What would TFTs show in primary hyper thyroidism?

A

TSH-low, T4- Raised, T3- Raised

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12
Q

What would TFTs show in Subclinical hyperthyroidism?

A

TSH-low, T4- normal, T3- normal

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13
Q

What would TFTs show in secondary hyperthyroidism?

A

TSH -high, T4- Raised, T3- Raised

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14
Q

What would TFTs show in primary hypothyroidism?

A

TSH -high, T4- low, T3- low

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15
Q

What would TFTs show in Subclinical hypothyroidism

A

TSH -high, T4- normal, T3- normal

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16
Q

Most common causes of thyrotoxicosis?

A

Graves disease
Toxic nodular goitre
Thyroiditis

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17
Q

Less common causes of hyperthyroid?

A

tsh secreting adenoma, neonatal, ectopic thyroid tissue, amiodorone

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18
Q

What is the Ab in Graves?

A

Anti TSHRAB

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19
Q

Signs and symptoms of hyperthyroid?

A

CVS: tachycardia, AF, SOBOE, ankle swellin, cardiomyopathy

GI: diarrhoea, wt loss, incr appetite

Eyes/skin: sore, gritty, double vision, staring, pruritis

Neuro: tremor, proximal myopathy, anxiety

Other: ht intolerance, sweating, oligo/amennorhea, osteoporosis

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20
Q

what does the goitre feel like in graves?

A

diffusely enlarged, bossellation, soft and symmetrical. May be a bruit

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21
Q

Eye disease in graves?

A 
Lid lag/retraction
conjunctival oedema (chemosis)
periorbital puffiness
proptosis
ophthalmoplegia
grittiness
exposure keratitis
optic neuropathy

assymetrical often, unilateral in 15%

RAPD may show optic nerve compression so get help.

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22
Q

Skin symptoms in graves?

Study These Flashcards
A

pretibial myxoedema
acropachy
vitiligo?

23
Q

Who should be screened for thyroid dysfunction?

Study These Flashcards
A 
Those with AF
hyperlipidaemia
DM
T1DM and pregnant
amiodoron or lithium
downs, turners, addisons disease
24
Q

Associated conditions with graves?

Study These Flashcards
A 
DM
Addisons
vitiligo
pernicious anaemia
alopecia areata
MG
coeliac
25
in first trimester what effect on tfts?
use diffferent references as tsh can be low in some women
26
Main risk factor in eye disease?
Smoking, 25-50%with graves will develop it. May not correlate with thyroid disease
27
Treatment for thyroid eye disease?
mild: conservative: lift bed etc Severe: steroids (methylpred) may help. Surgery may be needed if sight threatening
28
Initial Management of Graves?
Refer all with overt signs to endo Initially give a B Blocker to ameliorate symptoms First line is thionamides: CBZ and PTU compliance is better with CBZ and no chance of liver injury. most are euthyroid 8 weeks after. monitor every 6 weeks Remission 40% at 18 mo
29
S/E of thionamides?
liver injury: ptu agranulocytosis maculopapular rash vasculitis
30
When do you give PTU over CBZ?
pregnant, breast feeding, storm
31
C/I to radio iodine?
Active orbitopathy, pregnant, breast feeding stay away from preg and kids for 3 weeks no babies for 6mo (4 if man)
32
Risks of Radioiodine?
hypothyroidism, teratogenesis, optimal dose is unpredictable
33
when is surgery considered?
failed/intolerant to medical therapy, obstructive symptoms, malignancy suspected
34
complications of surgery?
``` hypo hypoPTH recurrent laryngeal nerve damage bleeding (v vascular thyroid in graves) storm ```
35
How can you prevent bleeding in thyroid surgery?
give lugols iodine, wolff chaikoff effect. large amounts of iodine reduces hormone
36
S+S of storm?
``` N+V confusion agitation acute abdo, cvs collaps, heart failre, incr. temp tachy AF ```
37
Precipitants of storm?
recent surgery/Radioiodine infection mi trauma
38
Management of storm?
iv saline take bloods for TFT Sedate if needed Propanolol, digoxin if need to slow heart carbimazole/ptu. lugols after 4 hours steroids abx for infection
39
Causes of hypothyroidism?
1o: iatrogenic: amiodorone, lithium, surgery/R/I AI: hashimotos, de quiervans, atrophic 2o: pituitary/hypothalamus tumours, trauma to either
40
symptoms of hypothyroidism?
tired, lethargic, mood down, cold intolerant, wt gain, constipation, hoarse voise, decreased memory/cognition, dementia, cramps, weakness
41
Signs of hypothyroidism?
``` Bradycardic B Reflexes slow Aataxia (cerebellar) Dry hair/skin Yawingin (tired) Cold intolerance Ascites +non pitting oedema Round face Defeated demeanor Immobile, ileus CCF ```
42
Causes of AI hypothyroidism?
primary atrophic: lymphcytic infiltration, no goitre as atrophy hashimotos: women 60-70, auto antibody titres high
43
problems in pregnancy with hypothyroidism?
eclampsia, anaemia, prematurity, low BW, still birth
44
Treatment for hypothyroidism?
Levothyroxine, 50-100ug | review at 12 weeks, adjust 6 weekly by clinical state but not to suppress TSH
45
Changes to treatment in elderly with hypothyroidism?
reduce dose to 25, increase carefully as may precipitate angina/mi
46
why is amiodorone a bugger in thyroids?
iodine rich, 2% get problems. hypo can be caused by toxic iodine excess, thyrotoxicosis from destructive thyroiditis that causes release. half like 80 days so problems persist
47
Myxoedema Coma signs
``` looks hypop old hypothermia low BG bradycardia coma seizures ``` may have had recent iodine/surgery. cyanotic, low bp and HF
48
management of Myxoedema Coma?
bloods oxygen if cyanosed correct hypoglycaemia T£ IV slowly hydrocortisone iv saline abx if infection
49
what can affect absorption of LT4?
Gi conditions: ibd, coeliac, gastritis | milk and coffee
50
Important flags for thyroid cancer?
solitary/multinodular lump, clinically euthyroid ``` FH LN swellin Hoarseness/change in voice Difficulty swallowing stridor ```
51
RF for thyroid cancer?
radiation exposure, neck irradiation
52
types of thyroid cancer?
paipillary follicular anaplastic medullary
53
why give steroids in thyrotoxic storm?
prevents peripheral conversion of t4 to t3

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