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Phase 2 (again) > Thyroid disorders > Flashcards

Thyroid disorders Flashcards

1
Q

Define hyperthyroidism

A

Overactivity of the thyroid gland resulting in excess thyroid hormone

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2
Q

Causes of hyperthyroidism (6)

A
  1. Grave’s disease (most common)
  2. Toxic multinodular goitre
  3. Toxic thyroid adenoma
  4. Pituitary adenoma -> more TSH, high T3/T4
  5. De Quervain’s thyroiditis
  6. Drug induced
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3
Q

Hyperthyroidism RF (5)

A
  1. Female
  2. Family history/genetic (HLA-DR3/4)
  3. Stress
  4. Smoking
  5. Amiodarone
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4
Q

Pathology of Graves’ disease

A
  • Serum IgG antibodies called TSH receptor stimulating antibodies (TRAb) bind to TSH receptors on thyroid and stimulate T3/4 production
  • Excess secretion, follicular hyperplasia, hyperthyroidism and goitre
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5
Q

Specific symptoms of Graves’ disease (4)

A
  1. Graves’ ophthalmology (extraocular muscle swellings - protruding eyes, lacrimation,, eye discomfort, diplopia)
  2. Pretibial myxoedema (raised purple/red symmetrical skin lesions over anterolateral aspect of the shins)
  3. Thyroid acropachy (finger clubbing, periosteal new bone formation)
  4. Goitre
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6
Q

Symptoms of hyperthyroidism (9)

A
  1. Weight loss
  2. Heat intolerance
  3. Irritability
  4. Sweating
  5. Insomnia
  6. Diarrhoea
  7. Palpitations
  8. Anxiety
  9. Menstrual disturbance
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7
Q

Signs of hyperthyroidism (9)

A
  1. Tachycardia/AF
  2. Tremor
  3. Goitre
  4. Hyperkinesia
  5. Lid lag
  6. Lid retraction
  7. Thin hair and hair loss
  8. Onycholysis - painless separation of the nail from nail bed
  9. Exophthalmos - bulging of eye
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8
Q

Investigations for hyperthyroidism (4)

A
  1. TFTs - primary = low TSH, high T3/T4, secondary = high TSH/T3/4
  2. Thyroid autoantibodies - thyroglobulin antibodies, TRAb, thyroid peroxidase antibodies (more in hypo)
  3. Thyroid ultrasound
  4. Radioactive iodine isotope uptake - high in Graves’
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9
Q

Treatment of hyperthyroidism (4)

A
  1. Beta blockers - reduces SNS activation
  2. Carbimazole - blocks thyroid hormone synthesis and is immunosuppressant
  3. Radioiodine therapy - iodine taken up and local irradiation and tissue damage
  4. Thyroidectomy - thyroid replacement needed
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10
Q

Complications of thyroidectomy (7)

A
  1. Bleeding
  2. Post-op infection
  3. Hypocalcaemia
  4. Hypothyroidism
  5. Hypoparathyroidism
  6. Recurrent laryngeal palsy - laceration
  7. Recurrent hyperthyroidism
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11
Q

Complications of hyperthyroidism

A
  1. Congestive HF
  2. AF
  3. Osteoporosis
  4. Graves’ ophthalmology complications
  5. Graves’ dermopathy - elephantitis
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12
Q

Thyroid crisis/storm

A

Rapid deterioration of thyrotoxicosis with

  1. Hyperpyrexia
  2. Tachycardia
  3. Restlesslessness
  4. Delirium, coma, death
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13
Q

What is thyroid crisis precipitated by?

A
  1. Infection
  2. Stress
  3. Surgery
  4. Radioactive iodine therapy
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14
Q

Treatment of thyroid crisis

A
  1. Large dose carbimazole
  2. Propranolol
  3. Potassium iodide - acutely block thyroid hormone release from gland
  4. Hydrocortisone - inhibit peripheral conversion of T4 to T3
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15
Q

Define hypothyroidism

A

Underactivity of the thyroid gland. Affects women more than men.

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16
Q

Causes of hypothyroidism (5)

A
  1. Post-partum thyroiditis
  2. Autoimmune thyroiditis
  3. Iodine deficiency
  4. Iatrogenic
  5. Congenital hypothyroidism
17
Q

Drugs inducing hypothyroidism

A
  1. Carbimazole
  2. Lithium
  3. Amiodarone
  4. Interferon
18
Q

Drugs inducing hyperthyroidism

A
  1. Iodine
  2. Amiodarone
  3. Lithium
19
Q

Signs of hypothyroidism : BRADYCARDIC

A 
Bradycardia
Reflexes relax slowly
Ataxia
Dry thin hair/skin
Yawning/drowsy/coma
Cold hands (+low temp)
Ascites (+non pitting oedema + pericardial/pleural effusion)
Round puffy face
Defeated demeanour
Immobile
CCF
20
Q

Symptoms of hypothyroidism (10)

A
  1. Weight gain
  2. Hoarse voice
  3. Goitre
  4. Cold intolerance
  5. Menorrhagia
  6. Constipation
  7. Lethargy/tiredness
  8. Poor memory
  9. Puffy eyes
  10. Arthralgia/myalgia
21
Q

Diagnosis of hypothyroidism

A
  1. High TSH, low T4
  2. Low TSH and T4 - rare pituitary fault
  3. High cholesterol and triglyceride, macrocytosis
  4. Normochromic anaemia (less common)
22
Q

Causes of primary hypothyroidism

A
  1. Primary atrophic hypothyroidism - lymphatic infiltration, atrophy, no goitre
  2. Hashimoto’s thyroiditis - lymphocytic and plasma cell infiltration, goitre, more common in women 60-70
  3. Iodine deficiency
  4. Thyroidectomy or radioiodine treatment
  5. Drug-induced
  6. Subacute thyroiditis
23
Q

Treatment of hypothyroidism

A
  1. Healthy and young - levothyroxine 0-100mcg/24h, review 12wks
  2. Elderly or ischaemic heart disease - 25mcg/24h

Aim to get TSH >0.5

24
Q

Types of thyroid cancer (good-> bad prognosis)

A
  1. Papillary
  2. Follicular
  3. Medullary cell
  4. Lymphoma
  5. Anaplastic
25
Q

Symptoms of thyroid cancer

A
  1. Thyroid nodules
  2. Dysphagia
  3. Hoarseness of voice
26
Q

Signs of thyroid cancer

A
  1. Lymph node metastases
  2. Bone or lung metastases (rare)
  3. Thyroid nodule with history of progressive increase in size
  4. Hard and irregular nodule
  5. Enlarged lymph nodes
27
Q

Investigations for thyroid cancer

A
  1. Fine needle aspiration cytology biopsy
  2. Thyroid ultrasound
  3. TFTs - hyper/hypothyroidism must be treated before surgery
28
Q

Treatment for thyroid cancer

A
  1. Papillary and follicular - total thyroidectomy with neck dissection, ablative radioiodine
  2. Anaplastic and lymphoma - external radiotherapy, mainly palliative

Phase 2 (again) (24 decks)

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