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Thyroid dysfunction Flashcards

1
Q

How is the thyroid gland examined?

A

Stand behind patient

Feel for thyroid using palmar surface of hands

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2
Q

Is a palpable thyroid gland normal or abnormal?

A

Always abnormal

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3
Q

What investigations are used for the thyroid gland?

Which is more commonly used and which is rarely used?

A

Ultrasound - commonly used

Radioiodine scanning - rarely used

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4
Q

What does radioiodine scanning involve?

A

Iodine given orally
Taken up by thyroid gland
Visible as black dots

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5
Q

What information does radioiodine scanning give about the thyroid gland?

A

Shape and structure of thyroid gland

Iodine uptake and thyroid function

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6
Q

What other element can be used instead of iodine?

A

Technetium

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7
Q

How is technetium given?

A

IV

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8
Q

What is the advantage of using technetium rather than iodine?

A

Can scan quicker

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9
Q

What is metabolic thyroid disease?

A

Thyroid gland over or under functioning

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10
Q

What is a pituitary adenoma?

A

Benign tumour of glandular epithelial tissue in pituitary gland

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11
Q

What is a complication of pituitary adenoma?

A

Excess TSH production
Over-stimulation of thyroid gland
Gives excess thyroid hormone, hyperthyroidism, thyrotoxicosis

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12
Q

How often does pituitary adenoma lead to thyrotoxicosis?

A

Rarely

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13
Q

What is a complication of pituitary failure?

A

Lack of TSH - hypothyroidism

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14
Q

What else can pituitary failure cause?

A

Lack of ACTH - adrenal glands affected

Lack of FSH, LH - affects gonads

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15
Q

What is the most common cause of metabolic thyroid disease?

A

Abnormality of thyroid

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16
Q

What is goitre?

A

Swelling of the thyroid gland

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17
Q

What are the different types of goitre?

A

Diffuse
Multinodular
Single nodule

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18
Q

What is a diffuse goitre?

A

Whole thyroid gland is swollen

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19
Q

What gender is goitre more common in?

Why?

A

Females

perhaps due to oestrogen/progesterone ratio over-stimulating thyroid

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20
Q

What causes goitre?

A

Over-stimulation of thyroid gland

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21
Q

What specific conditions can cause goitre?

A

Hypothyroidism
Hyperthyroidism
Iodine deficiency
Physiological

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22
Q

How can hypothyroidism cause goitre?

A

Raised TSH

over-stimulates thyroid

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23
Q

How is hyperthyroidism related to goitre?

A

Increased thyroid hormone secretion

means thyroid gland is over-stimulated

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24
Q

How can iodine deficiency cause goitre?

A

Gives reduced T4 secretion
raised TSH
over-stimulates thyroid

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25
What type of goitre is seen in iodine deficiency?
Generalised thyroid enlargement but nodular
26
What is the most common cause of goitre globally?
Iodine deficiency
27
What can severe iodine deficiency lead to?
Hypothyroidism
28
What is the complication of iodine deficiency during pregnancy?
Infant has cretinism
29
What are the features of cretinism?
``` Goitre Hypothyroidism Short stature Abnormal gait Mental retardation Deaf mutism ```
30
When can goitre be physiologal? What causes the goitre?
During menarche pregnancy menopause Oestrogen/progesterone ratio affecting thyroid function
31
What causes multinodular goitre? | Is thyroid function normal or abnormal?
Unknown cause | normal thyroid function
32
What is the most common cause of goitre in the UK?
Multinodular goitre
33
How many people develop toxic multinodular goitre?
Few people out of those who develop multinodular goitre
34
What is toxic multinodular goitre?
Multinodular goitre that leads to hyperthyroidism
35
What is a restrosternal multinodular goitre?
Multinodular goitre enlarges inferiorly into superior mediastinum behind sternum
36
What is a complication of retrosternal multinodular goitre? What is the sign of this complication?
Compression of trachea away from midline Gives inspiratory strider
37
What is hypothyroidism?
Underactive thyroid gland
38
What are T3 and T4 levels in hypothyroidism? Why?
Are low | because the thyroid gland is not producing, releasing thyroid hormone
39
What is the TSH level in hypothyroidism? Why?
Raised because of negative feedback loop less T3, T4 means less inhibition of anterior pituitary releases more TSH
40
What are the causes of hypothyroidism?
Autoimmune - Hashimoto's Iodine deficiency - severe cases Surgical removal, inadequate thyroxine replacement
41
What is the pathophysiology of Hashimoto's disease?
Antibodies against thyroglobulin, thyroid peroxidase destroy thyroid follicles may get initial inflammation due to this, small diffuse goitre
42
What is the final result of the thyroid gland in Hashimoto's disease?
Shrunken
43
What are the symptoms of hypothyroidism?
Excessive tiredness Muscle weakness Constipation Weight gain Puffy eyes, face, hands, feet Hair loss - outer third of eyebrows Dry, flaky skin Gruff, croaky voice Menorrhagia - heavy periods Memory issues Depression, together called myxodema madness Cold interolance
44
What are the signs of hypothyroidism?
Periorbital puffiness Coarse facial features Pallor Coarse brittle hair Bradycardia Hyporeflexia, delayed reflexes Myxodema - non pitting oedema Pericardial effusion Ascites
45
What causes myxoedema?
Deposition of mucopolysaccharides
46
What is the treatment for hypothyroidism?
Oral thyroxine T4
47
What should be considered in the dosage of oral thyroxine?
Serum TSH levels
48
Why can thyroxine be given orally?
Because it's not destroyed by gastric acid
49
What is thyrotoxicosis?
Condition of excess thyroid hormone | has many causes including hyperthyroidism
50
What is hyperthyroidism?
Overactive thyroid gland | Gives thyrotoxicosis
51
What are T3 and T4 levels with hyperthyroidism? Why?
Are raised | because thyroid gland is producing and releasing more of them
52
What are TSH levels with hyperthyroidism? Why?
Are low because of negative feedback loop raised T3, T4 give increased inhibition of anterior pituitary releases less TSH
53
What are the causes of hyperthyroidism?
Autoimmune - Graves disease Toxic multinodular goitre Toxic adenoma
54
What is the pathophysiology in Graves disease?
``` Thyroid stimulating immunoglobulin (TSI) in the blood binds to TSH receptor in thyroid gland stimulates it giving increased thyroid hormone synthesis and release ```
55
What is the pathophysiology of toxic adenoma?
Single adenoma in thyroid gland | produces thyroxine T4 on its own
56
What are the symptoms of hyperthyroidism?
Overactivity, leads to tiredness Shaking, trembling Proximal muscle weakness - buttocks, thighs Weight loss, increased appetite Diarrhoea Palpitations Angina - rare Increased sweating - warm sweaty hands Heat intolerance Insomnia Amenhorrea
57
What are the signs of hyperthyroidism?
Bounding pulse - wide pulse pressure Tachycardia Atrial fibrillation Lid lag Staring eyes Fine hand tremor Maybe goitre
58
What are the symptoms and signs specific to Graves disease?
Exopthalmus - bulging eyes Pre-tibial myxoedema - non-pitting oedema and discoloration of anterior leg
59
Why do patients with hyperthyroidism get lid lag and staring eyes?
Levator palpabrae superioris muscle 10% smooth muscle supplied by SNS over-stimulation of the smooth muscle (due to the increased number of receptors, response to catecholamines)
60
What does a toxic adenoma look like on a radioiodine scan?
Small dark region of thyroid, because takes up most iodine | rest of thyroid gland appears lighter
61
How is hyperthyroidism treated?
Carbimazole Thyroidectomy - surgical excision of thyroid gland Ablative dose of radioactive iodine - kills thyroid gland
62
What type of drug is carbimazole?
Pro-drug
63
What is carbimazole converted to inside the body?
Methimazole
64
How does methimazole work?
Inhibits thyroid peroxidase prevents it iodinating and coupling reduces T4 production and release
65
How long does it take for methimazole to have effect? Why?
Delayed effect | Because have thyroglobulin stores in colloid, need to be depleted first
66
How does thyroid cancer present?
Thyroid nodule
67
Does thyroid cancer cause metabolic thyroid disease?
No
68
How common is thyroid cancer?
Rare
69
What is the normal TSH range - wide or narrow? Why?
Wide because hypothalamus is constantly responding to stimuli e.g. temp. light altering TRH release, TSH

Endocrinology (14 decks)

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