Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 2 - Endocrine > Thyroid gland clinical > Flashcards

Thyroid gland clinical Flashcards

1
Q

Symptoms/signs of hypothyroidism (11) - think metabolism is lowered

A 
Weight Gain
Lethargy
Cold intolerance
Constipation
Mental slowness
Depression
Myalgia/ muscle weakness
Dry Skin/Hair
Bradycardia
Slow reflexes
GOITRE

Severe hypothyroidism
-puffy face, large tongue, hoarse voice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Symptoms/signs of hyperthyroidism (14) - think metabolism is increased

A 
Weight loss
Anxiety/irritability
Heat intolerance
Bowel frequency increase - diarrhoea
Frequent urination
Light periods
Sweating
Hair loss/thinning
Palpitations
Hyper-reflexia/tremors
GOITRE
Red/dry eyes
Osteoporosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

State the common tests of thyroid function and their interpretation, and the methods available for thyroid imaging.

A

TSH
FT4
FT3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe the levels of TSH, FT4 and FT3 in

  • primary hypothyroidism
  • subclinical (compensated) hypothyroidism)
  • secondary hypothyroidism
A

Raised TSH, Low FT4 & FT3

Raised TSH, Normal FT4 & FT3

Low (or normal) TSH, Low FT4 & FT3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is congenital hypothyroidism identified/screened for

A

screened for after birth in heel prick test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Management of hypothyroidism in the newborn

A

Levothyroxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Causes of primary hypothyroidism

  • congenital causes (2)
  • acquired causes (4)
A

Congenital

  • maldevelopment
  • dyshormonogenesis

Acquired

  • hashimoto’s thyroiditis/disease (autoimmune thyroiditis)
  • iatrogenic - from radioactive iodine, radiotherapy
  • chronic iodine deficiency
  • post partum thyroiditis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hashimoto’s thyroiditis aka

A

Chronic immune/lymphocytic thyroiditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Most common cause of primary hypothyroidism

A

Hashimoto’s disease (Autoimmune thyroiditis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Causes of central (i.e. pituitary or hypothalamus) hypothyroidism

  • neoplastic (2)
  • infiltrative (1)
  • traumatic (3)
  • iatrogenic (2)
A

neoplastic

  • pituitary tumour (prevents TSH production)
  • hypothalamus trauma or tumour

infiltrative
-infection, e.g. TB, syphilis

traumatic

  • head trauma
  • pituitary apoplexy
  • sheehan’s syndrome (pituitary necrosis due to blood loss and hypovolemic shock post birth)

iatrogenic

  • pituitary surgery
  • pituitary radiotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Signs of a pituitary mass causing hypothyroidism

A

Papilloedema

Bitemporal hemianopia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Biochemical investigations of primary hypothyroidism (e.g. Hashimoto’s thyroiditis) + typical findings of these (5)

hint: 2 autoantibodies

A

serum TSH - high

free serum T4 (FT4) - low

Autoantibodies

  • thyroid peroxidase (TPO) antibodies - elevated
  • anti-thyroglobulin antibodies - elevated

serum cholesterol - high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Treatment of primary hypothyroidism

A

Lifelong once daily levothyroxine (T4)

-initially 50 micrograms/day then adjust dose in increments of 12.5 to 25 micrograms to normalise TSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pathogenesis of Hashimoto’s disease (5)

A

Autoimmune destruction of thyroid involving thyroid peroxidase antibodies attacking the gland

  • lymphocytic infiltrate into the gland
  • destruction of thyroid follicles
  • apoptosis of thyroid epithelial cells
  • extensive fibrosis
  • Hurthle cell change
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Special situations where treatment of hypothyroidism (referring to dose of levothyroxine) differs to usual

A

IHD
-start at lower dose and increase cautiously as can precipitate angina

Pregnancy
-need increased dose as increased demand for thyroid hormone in foetus

Myxedema (aka SEVERE HYPOTHYRDOIDISM) coma
-may need IV T3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is myxoedema + what do you get it in

A

aka SEVERE HYPOTHYRDOIDISM

  • deposits of chains of sugar molecules (complex mucopolysaccharides) in the skin cause myxoedema
  • these compounds attract water, which lead to swelling

-swelling of face and esp lower legs

get it in hypo and hyperthyroidism (esp graves)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Levothyroxine doesn’t usually have side effects but over-treatment can lead to what side effect

A

Hyperthyroidism symptoms - sweating, chest pain, weight loss, palpitations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why is there the need to increase dose of levothyroxine during pregnancy

A

as extra thyroid hormone needed for foetal nervous development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Causes of a goitre (6)

A

Physiological

  • puberty
  • pregnancy

Autoimmune thyroiditis

  • grave’s disease
  • hashimoto’s disease

Non-autoimmune thyroiditis

Iodine deficiency

Dyshormogenesis

Goitrogens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Types of goitres (5)

A

Multinodular goitre

Diffuse goitre (colloid or simple)

Cysts

Tumours (adenoma or carcinoma or lymphoma)

Miscellaneous causes (sarcoidosis, TB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

A solitary thyroid nodule has risk of what

A

malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Investigations of a solitary thyroid nodule/ potential thyroid cancer (5)

A

TFTs - TSH, fT4

Ultrasound - differentiates benign v malignant

Fine needle aspiration (FNA) biopsy

Laryngoscopy - if vocal cords paralysed, suggests malignancy

Isotope thyroid scan - to look for hot/cold nodule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Nodules detected on a thyroid scan can be hot or cold

-what’s the difference

A

Thyroid scan involves giving radioactive iodine to see if there’s any region that’s over-producing or under-producing thyroid hormone

Hot nodule - a nodular region of the thyroid gland that takes up large amounts of radioactive iodine relative to the rest of the thyroid gland so it’s producing too much hormone and shows up darker

Cold nodule - nodule is composed of cells that do not make thyroid hormone (don’t absorb iodine) (i.e. non functioning nodule) so appears as defect/hole in the scan

24
Q

Do cold or hot solitary thyroid nodules have high risk of malignancy

A

Cold

25
Q

Types of thyroid cancer (4)

A

(Well) Differentiated thyroid carcinoma (good prognosis)

  • papillary
  • follicular

Anaplastic (poor prognosis; aggressive)

Lymphoma (poor prognosis; rare)

Medullary

26
Q

Most common type of thyroid cancer

A

Papillary thyroid cancer

27
Q

What underlies pathogenesis of most thyroid cancers

A

Genetic mutations

28
Q

Papillary thyroid carcinomas often spread to where

A

local lymph nodes

29
Q

Follicular thyroid carcinomas often spread to where

A

Lung/bone via blood rather than lymph

30
Q

Thyroid cancer management

  • differentiated thyroid cancers (3)
  • anaplastic (1)
  • medullary (2)
  • lymphoma (2)
A

Differentiated

  • thyroidectomy
  • radioactive iodine ablation after surgery
  • long term levothyroxine - to suppress TSH

Anaplastic
-palliative surgery if possible but treatment based on chemoradiotherapy as it’s aggressive and spreads so surgery not that helpful

Medullary

  • thyroidectomy
  • then thyroid replacement (levothyroxine) - replacement rather than suppression as medullary cancer not TSH sensitive

Lymphoma

  • chemotherapy
  • radiotherapy
31
Q

Describe anaplastic thyroid cancer

  • characteristic
  • spread
A

Aggressive
Locally invasive and can metastasise

doesn’t respond to radioactive iodine treatment

32
Q

Thyroid lymphomas are rare and generally arise from pre-existing what

A

Hashimoto’s thyroiditis

33
Q

Medullary thyroid cancer is a tumour of what cells of the thyroid

A

parafollicular C cells

34
Q

Medullary thyroid cancer is often associated with what genetic syndrome

A

Multiple endocrine neoplasia (MEN) type II

35
Q

MEN type II (a genetic syndrome) predisposes you to what conditions (3)

A

Medullary thyroid cancer
Phaeochromocytoma
Hyperparathyrodism

36
Q

Clinical features of thyroid cancer (5)

A

MAIN SIGN (may be the only sign people get)- palpable thyroid nodule - firm, immobile

If advanced

  • hoarseness
  • dysphagia
  • dyspnoea
  • cervical lymphadenopathy
37
Q

Describe the levels of TSH, FT4 and FT3 in

  • primary hyperthyroidism
  • subclinical (compensated) hyperthyroidism)
  • secondary hyperthyroidism
A

High FT4, FT3; Low TSH

Normal FT4, FT3; Low TSH

High FT4, FT3; High or normal TSH

38
Q

Cause of secondary hyperthyroidism (rare)

A

Pituitary adenoma secreting TSH

39
Q

Pathogenesis of grave’s disease

A

Immune system produces TSH receptor antibodies which excessively stimulate thyroid gland to produce thyroid hormones, and consequently also causing hypertrophy of gland

40
Q

Biochemical investigations of grave’s disease (4)

A

serum TSH - low

serum T4/T3 - high

detectable TSH receptor antibodies - specific to grave’s

high thyroid uptake of radioactive iodine test

41
Q

Untreated hyperthyroidism, particularly in older people, may result in what complications

A

cardiac arrhythmias, high-output cardiac failure, bone mineral loss

42
Q

Symptoms (3) /signs (7) of grave’s disease

A

Symptoms

  • heat sensitivity
  • sweating
  • palpitations/ fast irregular heartbeat –> AF

Signs

  • Graves’ ophthalmopathy - upper eyelid retraction, EXOPHTHALMOS, red etc
  • PRETIBIAL MYXOEDEMA (thyroid dermopathy)
  • acropachy - soft-tissue swelling of the hands and clubbing of the fingers
  • fine tremor
  • weight loss
  • DIFFUSE goitre
43
Q

Causes of thyrotoxicosis without hyperthyroidism (3)

A

Post partum thyroditis
Subacute (de Quervain’s) thyroiditis
Excessive therapeutic thyroxine

44
Q

What is subacute (de Quervain’s) thyroiditis

A

Painful swelling of the thyroid gland thought to be triggered by a viral infection, such as mumps or the flu

fever and pain in the neck

causes initial hyperthyroidism followed by transit hypothyroidism

45
Q

Palpitations and shakes/temors associated with thyrotoxicosis can be treated with

A

beta blockers

46
Q

Treatment of grave’s disease (hyperthyroidism) (4)

A

Antithyroid drugs

  • carbimazole
  • propylthiouracil

Radioactive iodine therapy +/- steroids

Thyroidectomy

beta blockers (propanolol)
-reduce symptoms of tremor, tachycardia and palpitations; doesn't cure the condition
47
Q

Antithyroid drugs given for hyperthyroidism can be given in what different regimens + which is favoured

A

Titration regimen - start high dose then reduce gradually when thyroid levels improve

Block-replace - blocking thyroid with constant dose then replacing with thyroxine when thyroid levels improve

Titration regimen because less side effects

48
Q

Who should radioactive iodine not be given to

A

Pregnant/breast feeding women

49
Q

Possible complications of treatment of hyperthyroidism

-side effects of radioactive iodine, antithyroid drugs (propylthiouracil, carbimazole)

A

High dose radioactive iodine -risk of hypothyroidism

Antithyroid drugs

  • propylthiouracil can be liver toxic
  • carbimazole and propylthiouracil may cause agranulocytosis
50
Q

What is cretinism

A

severe hypothyroidism in the newborn - classically the result of maternal iodine deficiency
–> physical and mental impairment

51
Q

In early stages of Hashimoto’s disease, damage to the thyroid follicles actually may cause a transient phase of what

A

hyperthyroidism due to release of thyroglobulin after damage of thyroid follicles

52
Q

Histological features of Hashimoto’s disease (4)

A

Dense lymphocyte and plasma cell infiltration –> lymphoid follicles

Colloid content reduced

Hurthle cell change - thyroid epithelium enlarge and develop eosinophilic granular cytoplasm

Fibrosis

53
Q

Histological features of Grave’s disease (3)

A

Hyperplasia of acinar epithelium
Reduced colloid content
Accumulation of lymphocytes with lymphoid follicle formation

54
Q

Why does grave’s disease cause opthlamopathy

A

Because ocular fibroblast cells also have TSH receptor which the TSH receptor antibodies can attack

55
Q

Are most follicular adenomas (thyroid tumour) functioning or non-functioning

A

Non-functioning

56
Q

Follicular adenoma v follicular carcinoma

A

Follicular adenoma - encapsulated tumour

Follicular carcinoma - malignant cells breach capsule and spread outmatch thyroid

57
Q

What thyroid cancer is characterised by psammoma bodies

A

papillary carcinoma

Year 2 - Endocrine (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions