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2a Endocrine > Thyroid Disorders and Thyroid in Pregnancy > Flashcards

Thyroid Disorders and Thyroid in Pregnancy Flashcards

1
Q

What happens in the thyroid axis?

A

Hypothalamus -> TRH -> AP -> TSH -> thyroid -> T3 and T4.

T3/4 have negative feedback effect on the pituitary gland and hypothalamus

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2
Q

What would happen to TSH levels if you under-active thyroid?

A

TSH would be raised as you have less T3/4 being produced and so no negative feedback.

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3
Q

What does low TSH indicate?

A

Low TSH indicates an over-active thyroid

Lots of T4 and T3 is being produced and so there is more negative feedback on the pituitary and less TSH.

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4
Q

What are the main functions of T3/4?

A
  1. Food metabolism.
  2. Protein synthesis.
  3. Increased sympathetic action e.g. CO and HR.
  4. Heat production.
  5. Needed for growth and development.
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5
Q

What are 5 causes of hypothyroidism?

A
  1. Autoimmune thyroiditis e.g. Hashimoto’s and atrophic thyroiditis.
  2. Post-partum thyroiditis.
  3. Iatrogenic - thyroidectomy.
  4. Drug induced e.g. carbimazole, amiodarone, lithium.
  5. Iodine deficiency.
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6
Q

What are 3 antibodies that would be present in someone with autoimmune thyroiditis?

A

1) TPO (Thyroid peroxidase)
2) Thyroglobulin
3) TSH receptor

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7
Q

What are examples of each type of hypothyroidism?

A

1) Transient: Post-partum thyroiditis
2) Iatrogenic: Thyroidectomy, Radioiodine therapy
3) Drugs: Carbimazole, Lithium, Amiodarone

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8
Q

What are main symptoms of hypothyroidism?

A

1) Menorrhagia - heavy bleeding
2) Obesity/weight gain
3) Malar flush
4) Tiredness/fatigue
5) Declining energy levels, depression
6) eye brows loss, dry skin and hair
7) Intolerance to cold
8) GOITRE (Swelling of the thyroid gland)

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9
Q

What are the main things to test for in hypothyroidism?

A

1) Thyroid Antibodies

2) TFT –> T3/4 low, TSH will be higher

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10
Q

How is hypothyroidism managed?

A

Levothyroxine

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11
Q

What are two of the main causes of hyperthyroidism?

A

1) Grave’s Disease

2) Toxic Adenoma

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12
Q

What is thyrotoxicosis and what are some of the main causes?

A

Def: Excess thyroid levels from possible causes

1) Increased production e.g. Graves, Adenoma
2) T3/4 leakage from follicular damage
3) Ingestion
4) Thyroiditis
5) Drug induced

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13
Q

What is the pathophysiology of Grave’s disease?

A

AI disease

1) TSH receptor antibodies stimulate thyroid hormone production
2) Hyperthyroidism

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14
Q

Give 5 symptoms of Grave’s disease that don’t include ophthalmopathy signs.

(See Hyperthyroidism signs)

A
  1. Weight loss.
  2. Increased appetite.
  3. Irritable.
  4. Tremor.
  5. Palpitations.
  6. Goitre.
  7. Diarrhoea.
  8. Heat intolerance.
  9. Malaise.
  10. Vomiting.
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15
Q

What are 5 non-opthalmopathic signs of Grave’s disease

A
  1. Tachycardia.
  2. Arrhythmias e.g. AF.
  3. Warm peripheries.
  4. Muscle spasm.
  5. Pre-tibial myxoedema (raised purple lesions over the shins).
  6. Thyroid acropachy (clubbing and swollen fingers).
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16
Q

What are 5 opthalmopathic signs of Grave’s disease?

A
  1. Exophthalmos (bulging eyes).
  2. Lid lag stare.
  3. Redness.
  4. Conjuctivitis.
  5. Pre-orbital oedema.
  6. Bilateral.
  7. Extra-ocular muscle swelling.
17
Q

What histological signs does Grave’s disease present?

A

Lymphocyte infiltration

Thyroid follicle destruction

18
Q

What are 3 methods of treatment for Grave’s disease?

A

1) Surgery (Thyroidectomy)
2) Anti-thyroid drugs (Carbimazole)
3) Radioiodine drugs

19
Q

How does carbimazole treat Grave’s disease and what is a potential side effect of taking it?

A

Targets thyroid peroxidase to prevent T3/T4 being produced

- Agranulocytosis

20
Q

What are potential complications of a thyroidectomy?

A
  1. Bleeding.
  2. Hypocalcaemia.
  3. Hypothyroidism.
  4. Recurrent laryngeal nerve palsy.
21
Q

How do radioiodine drugs work in treating Grave’s disease?

A

Thyroid hormone production is decreased, as radioiodine drugs emit beta particles destroying thyroid follicles

22
Q

What are the 5 metabolical changes that occur in pregnancy?

A
  1. Increased EPO, cortisol and N. Adrenaline
  2. High CO.
  3. High cholesterol and triglycerides.
  4. Pro thrombotic and inflammatory state.
  5. Insulin resistance.
23
Q

What are 6 syndromes found in gestational periods?

A

1) Gestational Diabetes
2) Pre-eclampsia
3) Obstetric cholestasis
4) Gestational thyrotoxicosis
5) Postnatal depression
6) Post-partum thyroiditis

24
Q

At what week are T4 and foetal thyroid follicles synthesised?

A

Week 10

25
Q

How can hCG activate TSH receptors and cause hyperthyroidism?

A

HCG/TSH both glycoprotein hormones that have similar structures
HCG activates TSH receptors.

26
Q

What are 3 potential problems if hypothyroidism is left untreated in pregnancy?

A

1) Gestational hypertension
2) Placental abruption
3) Low birth weight
4) Neonatal Goitre
5) Post-partum Haemorrhage

27
Q

What are 4 potential problems of hyperthyroidism in untreated cases in pregnancy?

A
  1. Intra-uterine growth restriction.
  2. Low birth weight.
  3. Pre-eclampsia.
  4. Risk of still birth/miscarriage.

2a Endocrine (6 decks)

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