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PM Important > Thyroid Disorders > Flashcards

Thyroid Disorders Flashcards

1
Q

Causes of hypothyroidism and associated general features:

A
  • Hashimoto’s: most common developed world, autoimmune, transient thyrotoxicosis acute phase, 5-10 times more common in women
  • Subacute (De Quervain’s) thyroiditis: painful goitre and raised ESR
  • Riedel thyroiditis: fibrous tissue displacement, painless goitre
  • Postpartum
  • Drugs: lithium, amiodarone
  • Iodine deficiency: most common developing world
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2
Q

Causes of hyperthyroidism:

A
  • Grave’s disease
  • Toxic multinodular goitre
  • Drugs: amiodarone
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3
Q

Typical symptoms of hypothyroidism:

A
  • cold intolerance
  • weight gain
  • lethargy
  • dry, anhydrous, yellowish skin
  • non-pitting oedema
  • dry scalp
  • loss of lateral aspect of eyebrow
  • constipation
  • menorrhagia
  • decreased deep tendon reflexes
  • carpal tunnel syndrome
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4
Q

Typical symptoms of hyperthyroidism:

A
  • heat intolerance
  • weight loss
  • restlessness
  • palpitations
  • increased sweating
  • pretibial myxoedema
  • thyroid acropachy: clubbing
  • diarrhoea
  • oligomenorrhea
  • anxiety and tremor
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5
Q

TSH and Free T4 in Thyrotoxicosis

A
  • low TSH

- High T4

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6
Q

TSH and Free T4 in Primary Hypothyroidism

A
  • high TSH

- low T4

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7
Q

TSH and Free T4 in Secondary Hypothyroidism

A
  • low TSH

- low T4

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8
Q

TSH and Free T4 in sick euthyroid syndrome

A
  • low/normal TSH

- low T4

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9
Q

TSH and Free T4 in subclinical hypothyroidism

A
  • high TSH

- normal T4

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10
Q

TSH and Free T4 in poor compliance with thyroxine

A
  • high TSH

- normal T4

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11
Q

Risk factor for Grave’s

A

smoking

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12
Q

Specific features of Grave’s disease

A
  • eye signs (30%): exophthalmos, diplopia, ophthalmoplegia
  • pretibial myxoedema
  • thyroid acropachy
  • autoantibodies: TSH receptor stimulating Ab (90%), anti-thyroid peroxidase Ab (75%)
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13
Q

Management of Grave’s disease

A
  • propranolol to block adrenergic effects
  • ATD titration (start carbimazole 40mg), 12-20 months
  • block and replace (thyroxine when euthyroid), 6-9 months
  • radioiodine (contra in pregnancy and <16yo)
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14
Q

What is Hashimoto’s associated with?

A

autoimmune disease, T1DM, Addison’s , pernicious anaemia

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15
Q

Secondary hypothyroidism causes:

A
  • pituitary failure
  • Down’s
  • Turner’s
  • Coeliac’s
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16
Q

Management of hypothyroidism:

A
  • 50-100mcg levothyroxine od
  • reduce to 25mcg od in elderly >50yo and ischaemic HD
  • if changing dose, TFTs in 8-12 weeks
  • increase dose by 25-50mcg in pregnancy
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17
Q

ADR of levothyroxine

A
  • hyperthyroidism
  • reduced bone mineral density
  • worsening angina
  • AF
18
Q

Signs of congenital hypothyroidism:

A
  • prolonged neonatal jaundice
  • delayed mental and physical milestones
  • short stature
  • puffy face, macroglossia
  • hypotonia
19
Q

Screening for congenital hypothyroidism

A

at 5-7 days with heel prick test

20
Q

Specific features in Hashimoto’s

A
  • goitre firm non-tender
  • anti-thyroid peroxidase and anti-thyroglobulin Ab
  • assocaited with development of MALT lymphoma, coeliac, T1DM, vitiligo
21
Q

Hormone profile, clinical features causes and treatment of primary hyperparathyroidism:

A 
Hormones:
-increased PTH
-increased calcium
-reduced phosphate
-urine calcium: creatinine CR >0.01 
-diagnose with technetium - MIBI subtraction scan 
Features:
-may be asymptomatic
-bones, stones, abdominal groans and psychic moans 
-polydipsia, polyuria
-recurrent abdominal pain (peptic ulcers, constipation, pancreatitis) 
-changes to emotional state
-pepperpot skull 
Causes:
-solitary adenoma
-hyperplasia 
-multiple adenoma 
-parathyroid carcinoma 
Treatment:
-total parathyroidectomy
-conservative if calcium <0.25mmol/L above upper limit and >50yo and no end organ damage
-calcimimetic agents e.g. cinacalcet
22
Q

Indications for surgery in primary hyperparathyroidism:

A
  • increased serum calcium
  • hypercalciuria
  • reduced creatinine clearance
  • episode of life threatening hypercalcaemia
  • nephrolithiasis
  • <50yo
  • neuromuscular syndrome
  • reduced bone mineral density
23
Q

Hormone profile, clinical features and causes of secondary hyperparathyroidism:

A 
Hormones:
-increased PTH
-increased phosphate
-reduced calcium
-reduced vit D
Features:
-bone disease
-osteitis fibrosa
-soft tissue calcifications
Causes:
-parathyroid gland hyperplasia
-almost always in setting of chronic renal failure
24
Q

Indications for surgery in secondary hyperparathyroidism:

A
  • bone pain
  • persistent pruritus
  • soft tissue calcifications
25
Q

Hormone profile, clinical features and causes of tertiary hyperparathyroidism:

A 
Hormones:
-increased PTH
-normal or increased calcium
-decreased or normal phosphate
-decreased or normal vit D
-increased ALP
Features:
-metastatic calcification
-bone pain/fracture
-nephrolithiasis
-pancreatitis 
Causes:
-ongoing parathyroid gland hyperplasia after correction of renal disorder
26
Q

Management of tertiary hyperparathyroidism:

A
  • allow 12 mo after transplant

- autonomously functioning may require surgery: excised or total parathyroidectomy and re-implanation of part of gland

27
Q

Signs and features of primary hypoparathyroidism:

A
  • reduced PTH
  • reduced calcium
  • increased phosphate
  • e.g. secondary to thyroid surgery
  • tetany, cramp and spasm, oral paraesthesia, Trousseau’s sign, Chvostek’s sign, chronic depression and cataracts, increased QT interval
28
Q

What is Trousseau’s sign?

A

carpal spasm if brachial artery occluded by BP cuff

29
Q

What is Chvostek’s sign?

A

tapping over parotid causes facial muscles to twitch

30
Q

Signs and features of pseudohypoparathyroidism:

A
  • target cells insensitive to PTH
  • increased PTH, reduced calcium, increased phosphate
  • low IQ, short, shortened 4th and 5th metacarpals
  • diagnose with urinary cAMP and phosphate after infusion of PTH (regular hypothyroid cAMP and phosphate both increase)
  • type I - no increase in either
  • type II - no increase in phosphate
31
Q

Why can you get thyroid problems in pregnancy?

A
  • increase in thyroxine binding globulin

- increase total thyroxine but not free thyroxine

32
Q

Thyrotoxicosis in pregnancy and management:

A
  • untreated increased risk of foetal loss, maternal HF and premature labour
  • Grave’s most common
  • manage with propylthiouracil in first trimester
  • carbimazole from second
  • no block and replace or radioiodine
  • keep maternal free thyroxine in upper third of normal to avoid foetal hypothyroidism
33
Q

Hypothyroidism in pregnancy management:

A
  • thyroxine safe in pregnancy and breastfeeding

- increased dose by 50% at 4-6 weeks

34
Q

What are the phases of subacute (De Quervain’s) thyroiditis?

A
  • 3-6 weeks: hyperthyroidism, painful goitre, raised ESR
  • 1-3 weeks: euthyroid
  • weeks-months: hypothyroidism
  • thyroid structure and function back to normal
35
Q

Investigations for Subacute thyroiditis:

A

thyroid scintigraphy: global uptake of iodine-131

36
Q

Management of subacute thyroiditis:

A
  • usually self-limiting
  • may respond to aspirin or NSAIDs
  • steroids if severe hypo
37
Q

Presentation of subclinical hyperthyroidism:

A
  • normal serum free thyroxine and triiodothyronine levels

- TSH below normal <0.1mu/L

38
Q

Presentation and management of subclinical hypothyroidism:

A
  • TSH raised but T3 and T4 normal
  • TSH 4-10mu/L: trial levothyroxine if <65yo and symptomatic (avoid hormonal treatment in elderly), asymptomatic observe and repeat TFTs in 6 months
  • TSH >10mu/L: treatment even if asymptomatic and <=70yo
39
Q

Types of thyroid cancer:

A
  • papillary: good prognosis
  • follicular
  • medullary: secrete calcitonin, part of MEN-2
  • anaplastic: not responsive to Tx
  • lymphoma: assoc with Hashimoto’s
40
Q

Causes, prevention and management of thyroid eye disease:

A
  • Grave’s disease
  • autoimmune response causing retroorbital inflammation - glycosaminoglycan and collagen deposition in muscles
  • smoking
  • radioiodine Tx makes worse
  • prednisolone may reduce risk
  • treat with topical lubricants to prevent corneal inflammation, steroids, radiotherapy, surgery
41
Q

Cause, precipitating factors, features and management of thyroid storm:

A
  • complication of thyrotoxicosis
  • surgery, trauma, infection, acute iodine load in CT contrast media
  • fever, achy, confusion and agitation, n&v, HTN, HF, abnormal LFTs
  • beta blockers, propylthiouracil and hydrocortisone
  • paracetamol, Lugol’s iodine, dexamethasone

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