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Abs Endo > Thyroid Gland > Flashcards

Thyroid Gland Flashcards

1
Q

what do follicular cells enclose

A

colloid

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2
Q

what does colloid contain

A

tyrosine containing thyroglobulin filled spheres

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3
Q

what do parafollicular C cells secrete

A

calcitonin

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4
Q

what is the main fuel for the thyroid gland

A

iodine

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5
Q

describe the synthesis and stoage of T3 and T4

A

iodine taken up by follicle cells
iodine attaches to tyrosine residues on thyroglobulin to form MIT and DIT
coupling of MIT + DIT = T3
coupling of DIT and DIT = T4

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6
Q

what is T4

A

thyroxine
accounts for 90%
converted to T3 by liver and kidney

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7
Q

what is T3

A

triiodothyronine
accounts for 10%
4x more potent
major biologically active hormone

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8
Q

properties of T3 and T4

A

hydrophobic and lipophilic so bind to plasma proteins

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9
Q

which plasma proteins do T3/T4 bind to

A

thyroxine binding globulin
thyroxine binding prealbumin
albumin

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10
Q

which form is biologically active - bound or unbound?

A

unbound

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11
Q

what is measured in hopsitals?

A

free T3/T4

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12
Q

states of increased TBG (increase total T4 but not fT4)

A 
pregnancy, newborn 
OCP, tamoxifen, clofibrate, heroin 
Hep A 
biliary cirrhosis 
acute intermittent porphyria
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13
Q

states of decreased TBG (decrease total T4 but not fT4)

A 
androgens 
cushings 
acromegaly 
systemic illness 
chronic liver disease 
nephrotic syndrome 
phenytoin, carbamzepine
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14
Q

metabolic effects of thyroid hormones

A

increase BMR and thermogenesis
increase blood glucose
mobilise fats from adipose tissue and increase fatty acid oxidation
increase protein synthesis

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15
Q

symptoms of hypothyroidism

A 
slow pulse 
fatigue 
cold intolerance 
tendency to put on weight easily 
myxoedema 
cretinism in babies
doughy skin 
periorbital puffiness
coarse, sparse hair 
constipation
hoarse voice
carpal tunnel 
menorrhagia
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16
Q

symptoms of hyperthyroidism

A 
fast pulse 
nervousness 
insomnia 
sweating 
heat intolerance 
tendency to lose weight easily 
palpitations 
tremor 
loose bowels 
eye symptoms 
brittle hair
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17
Q

most common thyroid cancer

A

papillary

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18
Q

worst prognosis thyroid cancer

A

anaplastic

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19
Q

types of differentiated thyroid cancer

A

papillary

follicular

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20
Q

features of differentiated tumours

A

take up iodine
secrete thyroglobulin
TSH driven
good prognosis

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21
Q

approximately how many present with mets in differentiated tumours

A

5%

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22
Q

spread of papillary

A

lymphatic

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23
Q

associations of papillary

A

Hashimoto’s thyroiditis

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24
Q

10yr mortality papillary

A

less than 5%

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25
Q

second most common thyroid cancer

A

follicular

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26
Q

spread of follicular

A

haematogenous

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27
Q

investigation of thyroid cancer

A

US guided FNA

excision for biopsy

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28
Q

gold standard treatment for thyroid cancer

A

surgery

  • lobectomy
  • subtotal or total thyroidectomy
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29
Q

AMES risk stratification

A

Age
Metastases
Extent of primary tumour
Size of primary tumour

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30
Q

what is it important to monitor post-operatively

A

calcium

31
Q

what can be used as a tumour marker of recurrence in patients who have had surgery to remove a tumour

A

thyroglobulin

32
Q

what is the most common cause of hypo or hyper thyroidism

A

autoimmune disease

33
Q

hormone levels in hyperthyroid

A

low TSH

high fT3/4

34
Q

hormone levels in hypothyroid

A

high TSH

low fT3/4

35
Q

most common cause of goitrous hypothyroidism

A

Hashimoto’s thyroiditis

36
Q

antibodies in Hashimoto’s

A 
thyroid peroxidase (TPO) 
occasionally anti-thyroglobulin
37
Q

what is seen on microscopy in Hashimotos

A

T cell infiltrate and inflammation

38
Q

other primary causes of hypothyroidism

A 
maternally transmitted 
iodine deficiency 
drug induced 
post-radiation/ablation 
subacute thyroiditis 
postpartum thyroiditis
39
Q

causes of secondary hypothyroidism

A

hypothalamic - congenital, infection, infiltration, malignancy
pituitary - panhypopituitarism, TSH deficiency

40
Q

management of hypo

A

thyroxine 50-100micrograms

in elderly with IHD, start at 25-50

41
Q

when is TSH an index of therapeutic success?

A

primary hypothyroidism

of no use in secondary

42
Q

what is myxoedema coma

A

severe hypothyroidism - typically affects old women with long standing hypothyroidism

43
Q

signs of myxoedema coma

A

ECG - bradycardia, low voltage complexes, heart block, T wave inversion, QT prolongation
Type 2 resp failure
adrenal failure

44
Q

treatment of myxoedema coma

A 
ABCDE 
passively rewarm 
cardiac monitoring 
monitor vitals 
broad spectrum ABx
45
Q

causes of hyperthyroid

A 
Graves 
multi-nodular goitre 
toxic nodule 
subacute thyroiditis 
post partum 
amiodarone, thyroxine and lithium treatment 
kelp supplements
46
Q

antibodies in Graves

A

TSH receptor antibodies

47
Q

eye disease in graves

A 
lid retraction 
lid lag 
chemosis 
proptosis 
visual loss 
diplopia 
exophthalmos
48
Q

features of nodular thyroid disease

A

older patients with insidious onset
feels nodular
asymmetrical goitre
high uptake on scintigraphy

49
Q

features of graves goitre

A

smooth symmetricl goitre
high scintigraphy uptake
see on US

50
Q

what is thyroid storm

A

medical emergency
severe hyperthyroidism with resp and cardiac collapse
hyperthermia and exaggerated reflexes

51
Q

Treatment of thyroid storm

A 
Lugols iodine (potassium iodide)
glucocorticoids 
PTU 
B Blockers 
fluids 
monitoring
52
Q

medication for hyperthyroidism

A

carbimazole
PTU (preferred in pregnancy)
radio-iodine

53
Q

side effects of carbimazole you do not want to miss

A

agranulocytosis

54
Q

medication for symptomatic relief

A

beta blockers - propanolol

these are sympathomimetic

55
Q

precautions with radio-iodine

A

no close contact for days after
no pregnancy for 6m after
high risk of hypothyroidism

56
Q

risks of surgery

A

scar, general risks
recurrent laryngeal nerve palsy
hypothyroidism/hypoparathyroidism

57
Q

what is DeQuervains thyroiditis

A

subacute viral
associated with sore throat/fever
usually self-limiting

58
Q

subclinical thyroid disease results

A

mildly overactive - TSH low, T3/4 normal

mildly failing - TSH high and T3/4 normal

59
Q

shin rash seen in Graves disease

A

pretibial myxoedema

60
Q

HLA haplotypes for hypothyroidism

A

DR3/DR5

61
Q

gene mutations in Hashimotos

A

CTLA-4 (negative regulator of T cell responses)

PTPN-22 (inhibitor of T cell function)

62
Q

hashimotos associated with higher risk of what

A

B cell lymphoma

63
Q

features of thyroid adenoma

A

discrete solitary mass

encapsulated by collagen cuff

64
Q

nodule in papillary carcinoma

A

usually solitary, can be multifocal

often cystic and may be calcified (psammoma bodies)

65
Q

features of anaplastic thyroid cancer

A

undifferentiated and aggressive

rapid growth

66
Q

features of medullary thyroid cancer

A

associated with MEN 2
rare
derived from C cells (neuroendocrine) and so can secrete calcitonin
composed of spindle or polygonal cells arranged in nests, trabeculae or follicles

67
Q

which type of cancer is associated with amyloid deposition

A

medullary

68
Q

treatment of medullary

A

total thyroidectomy

69
Q

Thy1

A

insufficient/uninterpretable

70
Q

Thy2

A

benign

71
Q

Thy3

A

atypia probably benign

72
Q

Thy4

A

atypia suspicious of malignancy

73
Q

Thy5

A

malignancy

Abs Endo (8 decks)

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