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2a RRS > thyroid disorders > Flashcards

thyroid disorders Flashcards

1
Q

hyperthyroidism clin features

A 
heat intolerance 
sweating 
weight loss 
tachycardia and palpitations 
hypertension 
dihorrea 
insomnia 
anxiety
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2
Q

what does thryoid hormone do

A

speeds up cells basal metabolic rate
cell = burns more energy (produces heat)
increases CO
stimulates bone resorption

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3
Q

what is the throid hormone pathway

A 
TRH (hypothalmamus)
TSH (ANTerior pit)
T3 and T4 release from follicular cells of thyroid gland 
t4 --> t3 in the peripheries
t3 t 4 inhib trh and tsh
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4
Q

symptoms of hyperthyroidism

A 
PRE EXAM
weight loss
oligomennorhoea
sweat
palpatations
diarrhoe
anxiety 
heat intol
tremor
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5
Q

signs of hyperthryoidism

A 
PRE EXAM
tachycardia
AF
lid lag and retraction (so tired pre exam)
goitre
thin hair
palmar erythema (skin remeber)
onycholysis
exophalamos
warm vasodilated peripheries
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6
Q

Causes of hyperthyroidism

A

graves disease, commonest
toxic multinodular goitre - due to iodine deficency
iodine excess, usually iatrogenic - exogenous
hyperfunctioning thyroid adenoma- TSH also high
thryoiditis
drugs - amioderone induced thyrotoxicosis

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7
Q

Dx of hyperthyroidism

A

serum TSH and t3 t4
PRIMARY CAUSE = low TSH high T3 T4
SECONDARY CAUSE = High TSH HIGH T3 T4 (secondary = 2 highs)
isoptope uptake scan
thyroid autoantibodies (TSH-receptor antibody)
glucose = high

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8
Q

Graves signs

A

exophthalmos
graves dermopathy - pretibial myxedema
goitre

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9
Q

Graves disease what is it pathophysiology and causes

A

autoimmune disease producing TSH-receptor antibodies
mimics TSH stimulating thyroid
this stimulation of thyroid causes hyperplasia and hypertrophy- goitre
retro orbital inflam or extra occualr msucles = exophlamous
pretibial Myxoedema - graves dermopathy

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10
Q

what is graves assos with

A

other autoimmune diseases
- pernicious anaemia,
type 1 DM,
Addison

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11
Q

Pharmacological treatment of graves disease

A

Propranolol -B Blocker- symptomatic treatment

Carbimazole -antithyroid - prevents T3/T4 synthesise

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12
Q

Surgical treatment of graves disease

A

radioidoine therapy

thyroidectomy

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13
Q

Graves disease onset, triggers and prevalence

A

Childbirth, Stress
more common in women 20-40
affects 2-5% of all women

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14
Q

complications of hyperthyroidism

A

thyroid storm = severe hypermetabolism = Pyrexia, arrhythmia hypovelemia potentially fatal
heart failure (to keep up with increased demmand from cells)
DM
osteoporosis (t3 t4 causes bone resoprtion)
angina
AF
infertility
Blindness due to opthalmopathy -graves

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15
Q

RF for graves

A

smoking

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16
Q

complication of surgery for hyperthyroidsm

A

=thryoidectomy -= hypOthyroidsm

damage reccurent laryngeal nerve - vocal cord paralysis

17
Q

hypothyroidism and prevalence

A

underactivity of the thyroid
1% prevalence 9% lifetime risk in women
10F=M

18
Q

complications of undiagnosed hypothyroidism

A

in childdren - poor development, slow growth
myxoedema coma - in stressful situ or poorly managed i.e long standing low thyroid hormone in the blood
=alterted conscious state, confusion
cold - hypothermia

19
Q

assos of hypothyroidism

A

say same as hyper
addisons
t1dm
pernicous anaemia

inherited = turners, cystic fibrosis

20
Q

signs of hypothyroidism

A 
BRADYCARDIC
Bradycardia
Reflexes relax slowly
Ascites/anaemia
Dry skin/hair
Yawning (anaemia)
Cold peripheries
Ataxia
Round puffy (weight gain)
Deep voice/defeated demanour = depression
Immobile
Congestive heart failure
21
Q

syptoms of hypothry

A 
cold intol *OPP
weight gain despite decrease in appetite **OPP
mennorrhagia 
constipation **OPP
oedema
lethargy 
depression
dry skin and hair
myalgia
22
Q

what do serum bloods show for primary vs secondary hypothyrodi

A 
primary = thryoid gland issue = low t3 t4 high TSH
secondary = pit issue = low TSH low t3 t4 (HYPOPITUITARISM)
23
Q

Causes of hypo thyroid primary

A 
hashimotos thyroiditis
primary atrophic hypothyroidism
iodine defic
post thyroidectomy / radio iodine
lithium/amiodarone
24
Q

causes of secondary hypothryoid

A

hypopituitarism

25
Q

what is hashimotos thyroiditsi

A

Autoimmune disease causing atrophy and regeneration= causes goitre.
presence of TPOAb
and anti TG

26
Q

Dx of primary hypothrydo

A

bloods - TSH = low t3 t4 high tsh
FBC - macrocytic anaemia
hypercholesterolaeimia
postive TPO antiboyd in hashimotos

27
Q

Mx of hypothyroidms

A

replacement therapy - L-thyroxine (t4 synthetic ) = LEVOTHYROXINE
titrated review at 6weeks
t4 not t3 as longer half life

28
Q

does amioderone cause hypo or hyperthyroidism

A

it causes both. anti arrhythmia drug that contains a lot of iodine

29
Q

thyroid cancer types

A

papillary (60%)
follicular (25%)
medullary (C-cells) (5%)
lymphoma (5%)

30
Q

which thyroid cancer most common

A

papillary

31
Q

mets of thyroid cancer

A 
BLBL
bone
liver
breast
lungs
32
Q

causes of prim secon tertiary hyperparathyroidsim

A

primary = due to parathyroid glands = parathyroid adenoma/carcinoma
4 gland hyperplasia
secondary - due to vit d or calcium deficiency - kidney not working so vit d defic (cant activate it) and no stim of ca absorp in gut (Chronic kidney disease)
tertiary - long term secondary - leads to pth hyperplasia = hyperplasia of PT glands, reanl fai.ure

33
Q

PTH Ca and Phosphate levels in the diff hyperparathyroids

A 
prim = high PTH High Ca low phosphate
secondary = high PTH low Ca high phosphate
tertiary = ALL high
secondary = kidney screwed so cant activate vit D required for Ca absorp hence low and cant reabsorb Ca or excrete Ph hence high phosphate
tertiary = long term secondary = hyperplasia of gland - high calcium
34
Q

what is the relationship between calcium phosphate and PTH

A

low calcium = high PTH
PTH stim calcium reabsorp from bone
the kindeys to reabsorb calicum and excrete phosphate and activate vit D(calcitriol)
calctriol – GI tract = increased absorption of Ca

35
Q

Cfs of primary hyperpaarathyroids

A 
get hypercalcaeimua therefore 
PSYCHIC MOANS - depression, confusion
GROANS - abdo pain, 
THRONES - constipation, polyuria polydyspia
STONES - kidney stones - renal colic
BONES - osteoporosis, bone pain
fatigue 
HTN
36
Q

investigations for primary hyperparathyroidism

A

Ca increased PTH increased (inapproriate) PO4- Decreased
DEXA scan
xray looks for bone changes

37
Q

Treatment for primary hyperparathyroidism

A

surgically remove adenoma (treat the cause)
increase fluid intake
reduce diatary calcium and vit D
(Cincalcet to reduce PTH)

38
Q

Tx for secondary hyperparathyroidism

A

vit D and calcium supplements

biphosphonates for bone

39
Q

Dx of hyperparathyroidism

A

DEXA bone scan - osteoporosis
24hr urinary calcium excretion in primary
serum PTH Ca Phosphate

2a RRS (26 decks)

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