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Endocrinology > Thyroid dysfunction > Flashcards

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
Q

What type of goitre is seen in iodine deficiency?

A

Generalised thyroid enlargement but nodular

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26
Q

What is the most common cause of goitre globally?

A

Iodine deficiency

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27
Q

What can severe iodine deficiency lead to?

A

Hypothyroidism

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28
Q

What is the complication of iodine deficiency during pregnancy?

A

Infant has cretinism

29
Q

What are the features of cretinism?

A 
Goitre
Hypothyroidism
Short stature
Abnormal gait
Mental retardation
Deaf mutism
30
Q

When can goitre be physiologal? What causes the goitre?

A

During menarche
pregnancy
menopause

Oestrogen/progesterone ratio affecting thyroid function

31
Q

What causes multinodular goitre?

Is thyroid function normal or abnormal?

A

Unknown cause

normal thyroid function

32
Q

What is the most common cause of goitre in the UK?

A

Multinodular goitre

33
Q

How many people develop toxic multinodular goitre?

A

Few people out of those who develop multinodular goitre

34
Q

What is toxic multinodular goitre?

A

Multinodular goitre that leads to hyperthyroidism

35
Q

What is a restrosternal multinodular goitre?

A

Multinodular goitre
enlarges inferiorly
into superior mediastinum
behind sternum

36
Q

What is a complication of retrosternal multinodular goitre? What is the sign of this complication?

A

Compression of trachea
away from midline

Gives inspiratory strider

37
Q

What is hypothyroidism?

A

Underactive thyroid gland

38
Q

What are T3 and T4 levels in hypothyroidism? Why?

A

Are low

because the thyroid gland is not producing, releasing thyroid hormone

39
Q

What is the TSH level in hypothyroidism? Why?

A

Raised
because of negative feedback loop
less T3, T4 means less inhibition of anterior pituitary
releases more TSH

40
Q

What are the causes of hypothyroidism?

A

Autoimmune - Hashimoto’s

Iodine deficiency - severe cases

Surgical removal, inadequate thyroxine replacement

41
Q

What is the pathophysiology of Hashimoto’s disease?

A

Antibodies against thyroglobulin, thyroid peroxidase
destroy thyroid follicles
may get initial inflammation due to this, small diffuse goitre

42
Q

What is the final result of the thyroid gland in Hashimoto’s disease?

A

Shrunken

43
Q

What are the symptoms of hypothyroidism?

A

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
Q

What are the signs of hypothyroidism?

A

Periorbital puffiness
Coarse facial features
Pallor
Coarse brittle hair

Bradycardia
Hyporeflexia, delayed reflexes

Myxodema - non pitting oedema
Pericardial effusion
Ascites

45
Q

What causes myxoedema?

A

Deposition of mucopolysaccharides

46
Q

What is the treatment for hypothyroidism?

A

Oral thyroxine T4

47
Q

What should be considered in the dosage of oral thyroxine?

A

Serum TSH levels

48
Q

Why can thyroxine be given orally?

A

Because it’s not destroyed by gastric acid

49
Q

What is thyrotoxicosis?

A

Condition of excess thyroid hormone

has many causes including hyperthyroidism

50
Q

What is hyperthyroidism?

A

Overactive thyroid gland

Gives thyrotoxicosis

51
Q

What are T3 and T4 levels with hyperthyroidism? Why?

A

Are raised

because thyroid gland is producing and releasing more of them

52
Q

What are TSH levels with hyperthyroidism? Why?

A

Are low
because of negative feedback loop
raised T3, T4 give increased inhibition of anterior pituitary
releases less TSH

53
Q

What are the causes of hyperthyroidism?

A

Autoimmune - Graves disease

Toxic multinodular goitre

Toxic adenoma

54
Q

What is the pathophysiology in Graves disease?

A 
Thyroid stimulating immunoglobulin (TSI)
in the blood
binds to TSH receptor in thyroid gland
stimulates it
giving increased thyroid hormone synthesis and release
55
Q

What is the pathophysiology of toxic adenoma?

A

Single adenoma in thyroid gland

produces thyroxine T4 on its own

56
Q

What are the symptoms of hyperthyroidism?

A

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
Q

What are the signs of hyperthyroidism?

A

Bounding pulse - wide pulse pressure
Tachycardia
Atrial fibrillation

Lid lag
Staring eyes

Fine hand tremor

Maybe goitre

58
Q

What are the symptoms and signs specific to Graves disease?

A

Exopthalmus - bulging eyes

Pre-tibial myxoedema - non-pitting oedema and discoloration of anterior leg

59
Q

Why do patients with hyperthyroidism get lid lag and staring eyes?

A

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
Q

What does a toxic adenoma look like on a radioiodine scan?

A

Small dark region of thyroid, because takes up most iodine

rest of thyroid gland appears lighter

61
Q

How is hyperthyroidism treated?

A

Carbimazole

Thyroidectomy - surgical excision of thyroid gland

Ablative dose of radioactive iodine - kills thyroid gland

62
Q

What type of drug is carbimazole?

A

Pro-drug

63
Q

What is carbimazole converted to inside the body?

A

Methimazole

64
Q

How does methimazole work?

A

Inhibits thyroid peroxidase
prevents it iodinating and coupling
reduces T4 production and release

65
Q

How long does it take for methimazole to have effect? Why?

A

Delayed effect

Because have thyroglobulin stores in colloid, need to be depleted first

66
Q

How does thyroid cancer present?

A

Thyroid nodule

67
Q

Does thyroid cancer cause metabolic thyroid disease?

A

No

68
Q

How common is thyroid cancer?

A

Rare

69
Q

What is the normal TSH range - wide or narrow? Why?

A

Wide
because hypothalamus is constantly responding to stimuli
e.g. temp. light
altering TRH release, TSH

Endocrinology (14 decks)

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