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Endocrinology > Thyroid disorders > Flashcards

Thyroid disorders Flashcards

1
Q

Systems affected by thyroid disease

A
  • energy
  • weight
  • temp
  • heart
  • nervosu ssytem
  • GI system
  • MSK
  • SKIN
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2
Q

Energy

Hypo-

Hyper-

A

Hypo- low

Hyper- high

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3
Q
A
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4
Q

Weight

Hypo-

Hyper-

A

Weight

Hypo- increase

Hyper- loss

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5
Q

Temperature

Hypo-

Hyper-

A

Hypo- cold

Hyper- heat intolerant

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6
Q

Heart

Hypo-

Hyper-

A

Hypo- bradycardic

Hyper- tachycardic

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7
Q

Nervous system

Hypo-

Hyper-

A

Hypo- lethargic

Hyper- hypersensitive/ nervous irritability

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8
Q

GI system

Hypo -

Hyper-

A

Hypo - constipated

Hyper- more frequent bowels

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9
Q

MSK

Hyper-

A

shake on outstretched movement

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10
Q

Skin

Hypo-

A

itching

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11
Q

blood test results of primary hypothyroidsm

A

T4 low (2.4 pmol/L (8-25)

TSH high (150 miU/L (1-4.5)

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12
Q

blood test results of primary hyperthyroidsm

A

T4 high (86 pmol/L (8-25)

TSH low (<0.05miU/L (1-4.5)

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13
Q

thryoid exam

A

Can only feel if enlarged

Feeling for nodules and perfuse swellings

Ask patient to swallow

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14
Q

radioisotope scan

A

Give Technetium-99m via IV- a good uptaker of iodine (inject)

Can see gland activity

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15
Q

thyroid ultrascan

A

best way- structural scan

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16
Q

plain X-ray and CT scan

A
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17
Q

old fashioned word for hypothyroidism

A

myxoedema

Swelling of eyes and thickened skin

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18
Q

symptoms of hypothyroidism

A

Symptoms

Tiredness

Weight gain

Cold intolerance

Change in appearance

Depression

Psychosis

Joint/ muscle ache

Dry hair/ skin

Constipation

Puffy eyes

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19
Q

signs of hypothyroidism

A

Peri-orbital oedema- swelling of the eyes

Loss of lateral eyebrows

Dry, thin hair

Bradycardia

Slow-relaxing reflexes

Carpal tunnel syndrome

Cold peripheries

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20
Q

causes of hypothyroidism

A

Autoimmune atrophic

Hashimotos’ thyroiditis

Post-partum thyroiditis

Dyshormonogenesis (babies born with under active thyroid)

Medication

Iodine deficiency

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21
Q

children of iodine deficient mother

A

all children have hypothyroidism

  • reduced IQ- cretinism
22
Q

Special situations in hypothyroidism

A

Myxoedema coma

Borderline or sub-clinical hypothyroidism

23
Q

Myxoedema coma

A

Severe hypothyroidism usually in the elderly.

Hypothermia and fluid overload in heart

50% mortality

24
Q

Borderline or sub-clinical hypothyroidism

A

Low/normal T4 and high TSH

More common than severe hypothyroidism

Can be monitored until symptoms warrant treatment

25
Q

treartment of hypothyroidism

A

Thyroxine replacement therapy

26
Q

Thyroxine replacement therapy

A

Levothyroxine (T4) for life

Starting dose depends on severity

100ug for young and fit person

More caution in elderly and heart disease

27
Q

aim of treatment with Thyroxine replacement therapy

A

Resolution of symptoms

Normalisation of blood tests (6-8 weeks)

High TSH suggests under replacement

Low TSH suggests over replacement

28
Q

symptoms of hyperthryoidism

A

Weight loss

Irritability

Restlessness

Insomnia

Malaise

Itching

Sweating

Palpitation

Tremor

Muscle ache

Diarrhoea

29
Q

signs of hyperthyroidism

A

Tremor

Hyperkinesis

Tachycardia

Atrial fibrillation (irreg irreg)

Warm peripheries

Hypertension

Proximal myopathy

Lid lag

30
Q

lid lag and hyperthyroidism

A
31
Q

Causes of hyperthryoidism

A

Graves disease

Nodular thyroid disease

Thyroiditis

32
Q

graves disease

A
33
Q

effects of graves

A

Graves ophthalmopathy

Pretibial myxoedema (Graves dermopathy)

Thyroid acropathy

34
Q

Thyroiditis

A

Inflammation of thyroid

Release of thyroxine into circulation

35
Q

causes of thyroiditis

A
  • Viral infection- de quervains thyroiditis
  • After birth- post partum
  • Medication- amiodarone
36
Q

nodular hyperthryoidism- single toxic nodule

A
37
Q

nodular hyperthryoidism- multi-nodular goitre

A
38
Q

Special situations in hyperthyroidism

A

Thyroid crisis or thyroid storm

Hyperthyroidism and pregnancy

39
Q

Thyroid crisis or thyroid storm

A

Rare condition with 10% mortality

Hyperpyrexia

Tachycardia

Cardiac failure

Liver dysfunction

Urgent treatment

40
Q

Hyperthyroidism and pregnancy

A
  • In graves disease antibodies can cross placenta
  • Baby can be born with hyperthyroidism
  • Requires close monitoring in pregnancy
41
Q

treatment for hyperthryoidism

A

medication, surgery or radioactive iodine

42
Q

medication for hyperthyroidism

A
  • Carbimazole
  • Beware of agranulocytosis (reduces neutrophils)
  • Beta blocker for symptom control
43
Q

Surgery for hyperthyroidism

A
  • If side effects on medication or patient preference
  • Good cosmetic results
  • Small risk of laryngeal nerves palsy’s and hypocalcaemia
44
Q

Radioactive iodine in treatment of hyperthyroidism

A

Good definitive non-surgical option

Contra-indicated in pregnancy

Radiation restriction guidance after treatment

45
Q

most goitees caused by thyroid nodules are in

A

women (7%)

men (1%)

46
Q

Types of goitre

A

Diffuse goitre

Simple goitre

Auto-immune

Thyroiditis

Nodular goitre

Multinodular goitre

solitary nodule (red flag )

Fibrotic goitre

Riedel’s thyroiditis – rare

Iodine deficiency

Common worldwide

Rare in UK

47
Q

Red flag symptoms of thyroid cancer: History

A
  • Very young or old patient
  • Rapid enlargement of lump in neck
  • Hoarse voice and dysphagia
  • Family history of thyroid cancer
48
Q

Red flag symptoms of thyroid cancer: examination

A
  • Hard irregular thyroid mass
  • Fixed to surrounding structures
  • Cervical lymph nodes
49
Q

Investigation of suspected thyroid cancer

A

Thyroid ultra sound

Fine need aspiration

CT scan thorax and mediastinum

50
Q

if cytology suggests cancer

A
  • Surgical removal
  • Prognosis is good

Endocrinology (12 decks)

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