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Medicine I > Thyroid Gland Disorders > Flashcards

Thyroid Gland Disorders Flashcards

1
Q

What is hyperthyroidism?

A

The clinical effect of excess thyroid hormone secretion usually from gland hyperfunction.

A wide range of conditions can cause hyperthyroidism, although Graves’ disease is the most common.

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2
Q

What constitutes the majority of hyperthyroidism cases?

A

Graves’ disease constitutes ⅔ of cases of hyperthyroidism.

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3
Q

What autoimmune disorder causes hyperthyroidism?

A

Graves’ disease.

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4
Q

What antibodies are produced in Graves’ disease?

A

Thyroid stimulating immunoglobulin (TSI) and TSH receptor antibody.

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5
Q

What can cause intrinsic thyroid autonomy?

A

Toxic solitary adenoma and toxic multinodular goiter (Plummer disease).

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6
Q

What are transient causes of hyperthyroidism?

A

Subacute thyroiditis and lymphocytic thyroiditis.

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7
Q

Name drugs that can induce thyrotoxicosis.

A

Amiodarone, alpha interferon, and lithium.

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8
Q

What excess substance can cause hyperthyroidism?

A

Excess iodine.

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9
Q

What is thyrotoxicosis factitia?

A

Excess exogenous L-thyroxine.

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10
Q

What is the clinical picture of Graves’ disease?

A

Hyperthyroidism with diffuse goiter, exophthalmos, and dermopathy.

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11
Q

What age group is commonly affected by Graves’ disease?

A

Patients age <50.

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12
Q

What is the gender ratio of Graves’ disease prevalence?

A

Women > men (9:1).

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13
Q

What can trigger Graves’ disease?

A

Stress, infection, and pregnancy.

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14
Q

What are common clinical findings in Graves’ disease?

A

Diffuse painless enlargement of the thyroid (goiter), nervous manifestations, cardiovascular manifestations, skin manifestations, gastrointestinal manifestations, and genital manifestations.

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15
Q

What are nervous manifestations of Graves’ disease?

A

Irritability, emotional lability, inability to sleep, tremors, proximal muscle weakness.

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16
Q

What cardiovascular symptoms are associated with Graves’ disease?

A

Dyspnea, palpitations, atrial fibrillation, angina, and possible cardiac failure.

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17
Q

What skin manifestations are seen in hyperthyroidism?

A

Excessive sweating, heat intolerance, warm and moist skin, palmar erythema, hair loss.

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18
Q

What are gastrointestinal manifestations of Graves’ disease?

A

Frequent bowel movements and vomiting, weight loss despite increased appetite.

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19
Q

What is subclinical hyperthyroidism?

A

Low TSH with normal T4 and T3 levels.

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20
Q

What is the diagnosis for Graves’ disease based on?

A

History and physical exam, lab studies including decreased TSH and elevated free T4 and T3.

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21
Q

What is a common treatment for hyperthyroidism?

A

Antithyroid medications such as methimazole or propylthiouracil.

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22
Q

What is the main side effect of carbimazole?

A

Agranulocytosis.

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23
Q

What is radioiodine treatment used for?

A

To achieve hypothyroidism due to destruction of the gland.

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24
Q

What are the indications for thyroidectomy?

A

Pregnancy, children, compressive symptoms from a large thyroid.

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25
What complications can arise from thyrotoxicosis?
Heart failure, angina, atrial fibrillation, osteoporosis, ophthalmopathy, gynecomastia.
26
What is the risk of developing thyroid storm?
Increased risk associated with active hyperthyroidism.
27
What is subclinical hyperthyroidism?
Occurs when there is low TSH, with normal T4 and T3. ## Footnote It leads to a 41% increase in relative mortality from all causes versus euthyroid control subjects.
28
What are the management steps for subclinical hyperthyroidism?
1. Confirm suppressed TSH is persistent (recheck in 2–4 months) 2. Check for non-thyroidal cause 3. Treat on an individual basis if TSH < 0.1 4. Options include carbimazole or propylthiouracil or radioiodine therapy 5. Recheck if no symptoms every 6 months.
29
What is thyroid storm?
An extreme form of thyrotoxicosis and an endocrine emergency. ## Footnote It is precipitated by stress, myocardial infarction, infection, thyroid surgery, or trauma.
30
What are the symptoms of thyroid storm?
High fever, extreme irritability, restlessness, delirium, coma, tachycardia, hypertension, heart failure, vomiting, jaundice, diarrhea, dehydration.
31
What is the initial step in diagnosing thyroid storm?
Do not wait for test results if urgent treatment is needed; perform TSH, free T4, and free T3 tests.
32
What is hypothyroidism?
A condition in which the thyroid gland doesn't produce enough of certain crucial hormones.
33
What is primary atrophic hypothyroidism?
A common autoimmune condition with a women:men ratio of approximately 6:1, characterized by diffuse lymphocytic infiltration of the thyroid leading to atrophy.
34
What is Hashimoto’s thyroiditis?
A condition that can cause goitre due to lymphocytic and plasma cell infiltration, more common in women aged 60–70 years.
35
What are other causes of primary hypothyroidism?
* Iodine deficiency * Post-thyroidectomy or radioiodine treatment * Drug-induced (antithyroid drugs, amiodarone, lithium) * Subacute thyroiditis * Dyshormonogenesis
36
What is secondary hypothyroidism?
Not enough TSH due to hypopituitarism; very rare.
37
What are associations seen with hypothyroidism?
* Autoimmune diseases (type 1 DM, Addison’s, vitiligo, pernicious anemia) * Turner’s and Down’s syndromes * Cystic fibrosis * Primary biliary cholangitis * POEMS syndrome
38
What are the clinical findings of hypothyroidism in newborns?
Cretinism, persistent physiologic jaundice, hoarse cry, constipation, somnolence, and feeding problems.
39
What are the adult symptoms of hypothyroidism?
* Tiredness * Lethargy * Cold intolerance * Decreased appetite * Weight gain * Constipation * Menorrhagia * Infertility * Hoarse voice * Decreased mood * Decreased memory/cognition
40
What are signs of hypothyroidism?
* Obesity * Goitre * Bradycardia * Dry thin hair/skin * Cold hands * Pale puffy face * Deep reflexes relax slowly
41
What is myxedema?
An advanced state of hypothyroidism characterized by an expressionless face, sparse hair, periorbital puffiness, large tongue, pale, cool skin.
42
How is hypothyroidism diagnosed?
Diagnosis is made by symptoms, physical findings, and lab tests confirming the condition.
43
What are the lab findings in primary hypothyroidism?
↑ TSH, ↓ T4, ↓ FT4, and T3 decreases in lesser extent.
44
What is the treatment for hypothyroidism in healthy and young patients?
Levothyroxine (T4), 0–100mcg/24h PO, adjusted every 6 weeks to normalize TSH.
45
What is the recommended initial dose of levothyroxine for elderly or ischemic heart disease patients?
Start with 25mcg/24h; increase by 25mcg every 4 weeks.
46
What should be monitored in pregnant patients with hypothyroidism?
TSH and free T4 should be monitored every month due to increased demand for thyroid hormones.
47
What is subclinical hypothyroidism?
Suspected if TSH > 4mU/L with normal T4 and T3, and no symptoms.
48
What is the risk of progression to frank hypothyroidism in subclinical hypothyroidism?
2%, increases as TSH increases.
49
What are the treatment recommendations for subclinical hypothyroidism if TSH ≥ 10mU/L?
Treat if there is a history of treated Graves’ or other autoimmune conditions.
50
What is myxedema coma?
The ultimate hypothyroid state before death, often seen in patients >65 years.
51
What are the signs and symptoms of myxedema coma?
* Signs of hypothyroidism * Hypothermia * Hyporeflexia * Low glucose * Bradycardia * Coma * Seizures
52
What is the preferred treatment setting for myxedema coma?
Preferably on ICU.
53
What is psychosis associated with hypopituitarism called?
Myxedema madness
54
What is the preferred treatment setting for hypopituitarism?
ICU
55
Which blood tests should be performed for hypopituitarism?
Free T3, free T4, TSH, FBC, U&E, cultures, cortisol, glucose
56
What is the typical dosage of T3 (liothyronine) for treatment?
5–20 mcg/12h IV slowly
57
What is the recommended hydrocortisone dosage if pituitary hypothyroidism is suspected?
100 mg/8h IV
58
What antibiotic is suggested if infection is suspected in hypopituitarism?
Co-amoxiclav 1.2 g/8h IV
59
What is the main complication to be cautious of when rehydrating a patient with hypopituitarism?
Cardiac dysfunction
60
What is the treatment for amiodarone-induced thyrotoxicosis Type 1?
Anti-thyroid therapy
61
What distinguishes Type 2 amiodarone-induced thyrotoxicosis?
Subacute thyroiditis with release of preformed thyroid hormones
62
Amiodarone-induced hypothyroidism is due to inhibition of what process?
Peripheral conversion of T4 to T3
63
What is thyroiditis characterized by?
Inflammation of the thyroid
64
What is the most common age group affected by subacute thyroiditis?
Decades 4 and 5
65
What lab findings are associated with subacute (de Quervain) thyroiditis?
Elevated erythrocyte sedimentation rate, decreased radioactive iodine uptake, initial elevation in T4 and T3
66
What is the primary treatment for subacute thyroiditis?
Symptomatic treatment with NSAIDs, prednisone, and propranolol
67
What is the main feature of Hashimoto thyroiditis?
Painless goiter
68
What antibodies are commonly found in Hashimoto thyroiditis?
Antimicrosomal antibodies, antithyroperoxidase antibodies
69
What is the treatment for Hashimoto thyroiditis?
L-thyroxine replacement
70
Lymphocytic thyroiditis is characterized by what type of thyroiditis?
Self-limiting episode of thyrotoxicosis
71
What is the typical duration of lymphocytic thyroiditis?
2–5 months
72
What is the treatment for lymphocytic thyroiditis?
Symptomatic treatment with propranolol
73
What causes Reidel thyroiditis?
Intense fibrosis of the thyroid and surrounding structures

Medicine I (3 decks)

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