Thyroid (hypo and hyper) Flashcards
hyperthyroidism TSH
low
hypothyroidism TSH
high
anti-TPO antibodies
graves disease and hashimotos thyroiditis
antibodies against thyroid gland
anti-thyroglobulin antibodies
antibodies against a protein produced and present in thyroid gland
TSH receptor antibodies
autoantibodies which cause graves disease
USS
thyroid nodules
cystic vs solid nodules
guide biopsy of thyroid lesion
radioisotope scan
hyperthyroidism and thyroid cancers
radioactive iodine IV
gamma camera
thyrotoxicosis
abnormal and excessive quantity or thyroid hormone in the body
primary hyperthyroidism
thyroid pathology
secondary hyperthyroidism
overstimulation by TSH
hypothalamus or pituitary
graves disease
autoimmune
TSH receptor antibodies
most common cause of hyperthyroidism
toxic multinodular goitre
nodules on thyroid act independently and produce excess thyroid hormone
exopthalmos
bulging of eyeball out of the socket caused by graves disease
inflamamtion, swelling and hypertrophy
pretibial myxoedema
mucin deposits under skin on anterior leg
discoloured, waxy, oedematous appearance
pretibial myxoedema is specific to what?
graves disease
reaction to TSH receptor antibodies
features of hyperthyroidism
anxiety and irritability sweating and heat intolerance tachycardia weight loss fatigue frequent loose stools
unique features of graves disease
diffuse goitre
graves eye disease
bilateral exopthalmos
pretibial myxoedema
unique features of multinodular goitre
goitre with firm nodules
age over 50
solitary toxic thyroid nodule
usually benign adenomas
surgical removal
De Quervains thyroiditis
viral infection with fever, neck pain and tenderness
dysphagia and hyperthyroidism features
then hypothyroidism
treating de quervains thyroiditis
NSAIDs and beta blockers
thyroid storm presentation
pyrexia
tachycardia
delirium
treating thyroid storm
fluids, anti-arrhythmics and beta blockers
Treating hyperthyroidism
carbimazole propylthiouracil radioactive iodine beta blockers surgery
2 treatment regimes of carbimazole
titration block
block and replace
propylthiouracil risks
hepatic reactions
how is radioactive iodine treatment used?
drink single dose of radioactive iodine
patients can be left hypothyroidism and require levothyroxine
strict rules radioactive iodine
not pregnant
avoid close contact with children for 3 weeks
beta blocker of choice
propanolol
blocks adrenergic activity
surgery - hyperthyroidism
whole thyroid or toxic nodules
hypothyroid post thyroidectomy
Most common cause of hypothyroidism in developed world
hashimotos thyroiditis
cause of hashimotos thyroiditis
autoimmune inflammation of thyroid gland
hashimotos thyroiditis antibodies
antithyroid peroxidase (anti-TPO) and antithyroglobulin antibodies
change in thyroid gland hashimotos thyroiditis
initial goitre then atrophy
most common cause worldwide of hypothyroidism
iodine deficiency
other causes of hypothyroidism
anti-thyroid medications eg carbimazole, thyroid surgery
lithium
pituitary gland
lithium and thyroid
inhibits production of thyroid hormones
goitre and hypothyroidism
amiodarone and thyroid
interferes with thyroid hormone production and metabolism
can cause hypothyroidism and thyrotoxicosis
secondary hypothyroidism
pituitary gland fails to produce enough TSH
hypopituitarism
causes of secondary hypothyroidism
tumours
infection
vascular - sheehan
radiation
presentation of hypothyroidism
weight gain fatigue dry skin coarse hair and hair loss fluid retention heavy or irregular periods constipation
differentiating primary and secondary hypothyroidism
primary = high tsh and low t3 and t4 secondary = low tsh and low t3 and t4
management of hypothyroidism
oral levothyroxine (synthetic t4 metabolised to t3)
changing dose of levothyroxine
if TSH is high the dose is too low and vice versa
check bloods monthly until TSH stable
