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Endocrine > Thyroid + Parathyroid > Flashcards

Thyroid + Parathyroid Flashcards

1
Q

what are the 5 main histological classifications of thyroid cancers?

A 
papillary
follicular
medullary 
anaplastic
other
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2
Q

which is the most common histological classification of thyroid cancer?

A

papillary

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3
Q

what histological appearance does differentiated thyroid cancer refer to?

A

papillary and folicular variants

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4
Q

do differentiated thyroid cancers tend to take up iodine?

A

yes

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5
Q

what do differentiated thyroid cancers tend to secrete?

A

thyroglobulin

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6
Q

what hormone drives differentiated thyroid cancers?

A

TSH

thyroid stimulating hormone

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7
Q

what risk factor has a strong association with thyroid cancer?

A

radiation exposure

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8
Q

do papillary thyroid cancers tend to spread via haematogenous spread or lymphatic spread?

A

lymphatic spread

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9
Q

what autoimmune condition is papillary thyroid cancer associated with?

A

Hashimoto’s thyroiditis

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10
Q

what is Hasimoto’s thyroiditis?

A

an autoimmune condition where the thyroid gland is attacked by a variety of cell and antibody mediated processes

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11
Q

what is the second most common histological type of thyroid cancer?

A

follicular

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12
Q

what thyroid cancer has a slightly higher incidence in regions relative to iodine deficiency?

A

follicular carcinoma

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13
Q

do follicular thyroid carcinomas tend to spread via haematogenous spread or lymphatic spread?

A

haematogenous spread

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14
Q

why is it uncommon to find lymph node enlargement in follicular thyroid carcinomas?

A

because lymphatic spread is rare

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15
Q

what are the 2 main ways of investigating a suspected thyroid cancer?

A

ultrasound guided fine needle aspiration

excisional biopsy of lymph node

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16
Q

what is the treatment of choice for a differentiated thyroid cancer?

A

surgery

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17
Q

what are the 3 main surgical options for thyroid cancer?

A
  • thyroid lobectomy with isthmusectomy
  • sub-total thyroidectomy
  • total thyroidectomy
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18
Q

what are the 5 indications for total or subtotal thyroidectomy for a patient with thyroid cancer?

A
  • DTC with extra thyroidal spread
  • bilateral/multifocal DTC
  • DTC with distant mets
  • DTC with nodal involvement
  • patient in AMES high risk group
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19
Q

when is whole body iodine scanning used post operatively?

A

in patients who have undergone subtotal or total thyroidectomy

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20
Q

how long post-op is whole body iodine scanning used after a subtotal or total thyroidectomy?

A

3-6 months

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21
Q

before a whole body iodine scan, when is T3 and T4 stopped?

A

T3 two weeks before

T4 four weeks before

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22
Q

if there is iodine uptake >0.1% in thyroid bed on whole body iodine scan post total/subtotal thyroidectomy, what is the management?

A

total remnant ablation

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23
Q

what are the 3 hormones the thyroid gland secretes?

A

thyroxine (T4)
tri-iodothyronine (T3)
calcitonin

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24
Q

what is a thyroid follicle made of?

A

follicular cells enclosing a colloid

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25
Q

what is the colloid filled with?

A

thyroglobulin

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26
Q

what are the cells within the thyroid gland that aren’t contained within the follicles?

A

parafollicular C cells

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27
Q

what hormone do parafollicular C cells contain?

A

calcitonin

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28
Q

what is the function of calcitonin?

A

minor role in calcium regulation

lowers serum calcium

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29
Q

compare the structure of T3 and T4?

A 
T3 = MIT + DIT
T4 = DIT + DIT
MIT = monoiodotyrosine unit
DIT = di-iodotyrosine unit
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30
Q

where are T3 and T4 stored until required?

A

in colloid thyroglobulin

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31
Q

carbimazole and propylthiouracil are used in the treatment of hyperthyroidism, how do they work?

A

stop iodine attaching to the tyrosine units

therefore slow T3 and T4 production

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32
Q

which is secreted more- T3 or T4?

A

T4

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33
Q

which is more biologically active- T3 or T4?

A

T3

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34
Q

what is the main stimulus for T3 and T4 to be pulled in from colloid and to move across the follicular cell into the blood stream?

A

TSH from the pituitary gland

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35
Q

what are the 3 main carrier proteins for T3 and T4?

A

thyroxine binding globulin
thyroxine binding prealbumin
albumin

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36
Q

what do thyroid hormones do to basal metabolic rate?

A

increase basal metabolic rate

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37
Q

what do thyroid hormones do to thermogenesis?

A

increase thermogenesis

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38
Q

why do patients with hyperthyroidism present with shaking, sweating and palpitations?

A

increased responsiveness to adrenaline and noradrenaline (sympathetic ANS)

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39
Q

why is propanolol used in the treatment of hyperthyroidism?

A

to block exaggerated effect of sympathetic nervous system

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40
Q

what hormone, released from the hypothalamus, stimulates the release of TSH from the pituitary gland?

A

thyrotrophin releasing hormone

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41
Q

what hormones do T3 and T4 exert negative feedback control over?

A

Thyrotrophin Releasing Hormone (TRH)

Thyroid Stimulating Hormone (TSH)

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42
Q

what does stress do to the TRH and TSH release?

A

inhibits TRH and TSH release

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43
Q

when are the thyroid hormones at their highest and lowest?

A

thyroid hormones highest late at night

lowest in the morning

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44
Q

compare primary and secondary causes of hypothyroidism in terms of goitre (enlarged thyroid)?

A

primary gland failure- may have a goitre

secondary to TRH or TSH- no goitre

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45
Q

what is cretinism?

A

dwarfism and limited mental functioning due to deficiency of thyroid hormones present at birth

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46
Q

what is grave’s disease?

A

an autoimmune disease causing hyperthyroidism

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47
Q

what antibodies are present in grave’s disease and what is their function?

A

anti-TSH receptor antibodies:

  1. thyroid stimulating Ig
  2. thyroid growth stimulating Ig
  3. TSH binding inhibitor Ig

act in the same way as TSH but aren’t inhibited by T3 and T4

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48
Q

why can eyes bulge in hyperthyroidism?

exopthalmos

A

water retaining carbohydrate build up between the eyes

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49
Q

what is the anterior triangle of the neck bordered by?

A

superiorly- mandible
medially- midline
laterally- sternocleidomastoid

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50
Q

what is the posterior triangle of the neck bordered by?

A

inferiorly- clavicle
anteriorly- sternocleidomastoid
laterally- trapezius

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51
Q

when do thyroglossal cysts tend to present?

A

teenage years

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52
Q

what is a distinct feature of thyroglossal cysts?

A

moves with tongue

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53
Q

when do dermoid cysts tend to present?

A

teenage years

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54
Q

when do branchial cysts tend to present?

A

teenage years

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55
Q

when do cystic hygromas tend to present?

A

in 1sy year

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56
Q

compare primary hyperthyroidism to pituitary disease causing secondary hyperthyroidism in terms of levels of T3/4 and TSH?

A

primary: low TSH, high T3/4
secondary: high TSH, high T3/4

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57
Q

compare primary hypothyroidism to pituitary disease causing secondary hypothyroidism in terms of levels of T3/4 and TSH?

A

primary: high TSH, low T3/4
secondary: low TSH, low T3/4

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58
Q

what is myxoedema coma?

A

severe hypothyroidism

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59
Q

is pretibial myxoedema seen in hypo or hyperthyroidism?

A

hyperthyroidism

only Grav’es disease

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60
Q

what is pretibial myxoedema?

A

accumulation of hydrophilic mucopolysaccharides in the dermis
(usually seen in shins)

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61
Q

what are the 3 main classes of causes of primary hypothyroidism?

A

goitrous
non-goitrous
self-limiting

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62
Q

is chronic thyroditis (hashimoto’s thyroditis) a goitrous or non-goitrous cause of primary hypothyroidism?

A

goitrous

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63
Q

is atrophic thyroditis a goitrous or non-goitrous cause of primary hypothyroidism?

A

non-goitrous

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64
Q

is iodine deficiency a goitrous or non-goitrous cause of primary hypothyroidism?

A

goitrous

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65
Q

what is the most common cause of hypothyroidism in the western world?

A

Hashimoto’s thyroiditis

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66
Q

what is Hashimoto’s thyroiditis?

A

autoimmune destruction of the thyroid gland causing reduced production of thyroid hormones

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67
Q

what antibodies are present in Hashimoto’s thyroditis?

A

anti- thyroid peroxidase

anti-thyroglobulin

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68
Q

why does hypothyroidism cause hyperprolactinaemia?

A

decreased T3/4 causes increased TRH and TSH

increased TRH causes increased prolactin secretion

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69
Q

what dose of thyroxine should you start younger patients with hypothyroidism on?

A

50-100 micrograms

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70
Q

what dose of thyroxine should you start an older patient with history of ischaemic heart disease with newly diagnosed hypothyroidism on?

A

25-50 micrograms

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71
Q

once the dose of thyroxine has been estabilished, and hypothyroidism has been stabilised, how often should TSH levels be checked?

A

12- 18 months

72
Q

why might exogenous thyroxine dose requirement increase during pregnancy?

A

because there is increased thyroxine-binding-globulin

73
Q

compare primary and secondary hypothyroidism in the use of TSH levels as an indicator for if thyroxine treatment is working?

A

primary: TSH is a good indicator- will be low when T4 treatment is successful

secondary: TSH is not a good indicator, will be low regardless of if the treatment is successful
(in this case montor T4 levels)

74
Q

what are the 5 findings of myxoedema coma on ECG?

A
  • bradycardia
  • low voltage complexes
  • varying degrees of heart block
  • inversion of T wave
  • prolongation of QT interval
75
Q

does myxoedema coma give type 1 or type 2 respiratory failure?

A

type 2 respiratory failure

76
Q

what is the treatment of hyperthyroidism?

A

carbimazole
or
propylthiouracil
(+ symptomatic control with beta blockers for example)

77
Q

in graves disease what is the treatment?

A

carbimazole/propylthiouracil
high dose then reduce over 12-18 months before stopping
(50% relapse risk)

78
Q

what are the levels of T4 and TSH in sub-acute thyroditis?

A

T4- high in early stage, then low, then normal

TSH- low in early stage, then high, then normal

79
Q

does amiodarone-induced thyrotoxicosis occur more frequently in areas with low or high iodine intake?

A

low iodine intake

80
Q

does amiodarone-induced hypothyroidism occur more frequently in areas with low or high iodine intake?

A

high iodine intake

81
Q

what are the levels of TSH and T3/4 in subclinical hyperthyroidism?

A

TSH- low

T3/4- normal

82
Q

what are the levels of TSH and T3/4 in subclinical hypothyroidism?

A

TSH- high

T3/4- normal

83
Q

what vertebra level does the thyroid tend to be at?

A

C5/6 -T1

84
Q

embryologically, the thyroid descends from the foramen caecum to normal location along what duct?

A

thyroglossal duct

85
Q

what embryological abnormality causes a lingual thyroid?

A

failure of thyroid descent

86
Q

what embryological abnormality causes a retrosternal thyroid?

A

excessive descent

87
Q

what embryological abnormality causes a thyroglossal duct cyst?

A

patent thyroglossal duct

88
Q

where are TSH receptors found?

A

on the surface of thyroid epithelial cells

89
Q

what happens to the intracellular levels of cAMP when TSH binds to the TSH receptors on teh surface of the cell?

A

increases cAMP levels

90
Q

what does increasing intracellular concentration of cAMP levels within thyroid epithelial cells lead to? (in terms of hormone production)

A

increased T3/T4 production and release

91
Q

what response elements within target genes, do T3/T4 bind to?

A

thyroid response elements

92
Q

polymorphisms in what type of genes are associated with autoimmune thyroditis?

A

polymorphisms in immune regulation genes

93
Q

what is thyrotoxicosis?

A

symptoms and signs that occur as a result of excess T3 and T4

94
Q

what causes 85% of cases of hyperthyroidism?

A

grave’s disease

95
Q

what age group does Grave’s tend to appear in?

A

20-40 year olds

96
Q

what antibodies produced in grave’s disease may explain the episodes of hypofunction?

A

TSH binding inhibitor Ig

97
Q

does iodine deficiency cause hyper or hypothyroidism?

A

hypothyroidism

98
Q

what age group does Hashimoto’s thyroiditis tend to occur in?

A

40 - 60 years old

99
Q

as well as autoantibodies, what cell type are important in the destruction of thyroid tissue in hashimoto’s?

A

cytotoxic T cells

100
Q

as well as autoantibodies and cytotoxic T cells, what proteins are important in the destruction of thyroid tissue in hashimoto’s?

A

cytokines

esp gamma interferon

101
Q

what may precede Hashimoto’s thyroiditis?

A 
transient hyperfunction
(Hashitoxicosis)
102
Q

what form of malignancy is a recognised complication of Hashimoto’s thyroidits?

A

B cell NHL

a lymphomas

103
Q

what is a goitre?

A

an enlargment of the thyroid gland

104
Q

what are the 2 main types of goitre?

A

diffuse goitre

multinodular goitre

105
Q

why does hypothyroidism cause goitre?

A

reduced T3/T4 production causes increased TSH levels which stimulates gland enlargment

106
Q

what is the classic evolution of a goitre?

A

long standing diffuse goitre becomes a multi-nodular goitre

107
Q

what cells are papillary and follicular thyroid carcinomas derived from?

A

thyroid follicular cells

108
Q

do thyroid adenomas tend to be functional or non-functional?

A

non-functional

109
Q

some adenomas are functional, what condition does this cause?
is this condition TSH dependent or independent?

A

thyrotoxicosis

TSH independent

110
Q

what cells are medullary thyroid carcinomas derived from?

A

parafollicular C cells

111
Q

how do you tell the difference between a follicular adenaoma and a follicular carcinoma in the thyroid gland?

A

follicular carcinoma needs vascular or capsular invasion

112
Q

why can medullary thyroid carcinomas cause diarrhoea?

A

due to paraneoplastic syndrome: production of VIP

113
Q

why can medullary thyroid carcinomas cause cushinds?

A

due to paraneoplastic syndrome: production of ACTH

114
Q

describe the Thy 1 - Thy 5 thyroid cytology assessments?

A 
Thy 1 - insufficient aspirate
Thy 2 - benign
Thy 3 - atypia, but probably benign
Thy 4 - atypia, suspicious of malignancy
Thy 5 -malignant
115
Q

what cells are the parathyroid glands composed of?

A

chief cells supported by oxyphil cells

116
Q

what hormone do chief cells within the parathyroid glands produce?

A

PTH

117
Q

what is the function of PTH?

A

Calcium homeostasis

118
Q

what is almost always the cause of hyperparathyroidism?

A

small adenomas

119
Q

what are the 3 causes of hyperparathyroidism?

A

adenomas
hyperplasia
carcinoma

120
Q

compare adenoma of parathyroid to hyperplasia of parathyroid in terms of glands affected?

A

adenoma: tends to be single gland
hyperplasia: tends to involve all glands

121
Q

what causes secondary hyperparathyroidism?

A

chronic hypocalcaemia

122
Q

what is the commonest cause of hypoparathyroidism?

A

post-op

123
Q

what genetic condition can cause hypoparathyroidism?

A

Di George Syndrome

124
Q

what happens to the binding of TBG in pregnancy?

A

binding increases

increases demand on thyroid

125
Q

high levels of what hormone cause hyperemesis gravidarum?

A

high hCG

126
Q

what does hCG do to the concentrations of TSH and T4?

A

high T4

causing neg feedback on TSH so low TSH

127
Q

what is hyperemesis gravidarum?

A

severe sickness in pregnancy

128
Q

as soon as pregnancy is suspected, what should you increase thyroxine dose by in a patient with hypothyroidism?

A

25 micrograms

129
Q

what is gestational hCG-associated thyrotoxicosis?

A

when excess hCG (hyperemesis gravidarum) causes increased T4 leading to thyrotoxicosis

130
Q

when should gestational hCG-associated thyrotoxicosis resolve by?

A

20 weeks

131
Q

as levels of hCG increase what happens to the levels of thyroxine and the levels of TSH?

A

levels of thyroxine increase

levels of TSH decrease (due to T4 negative feedback)

132
Q

why can transient neonatal thyrotoxicosis occur in a baby born to a mother with grave;s disease?

A

transient thyrotoxicosis due to graves antibodies crossing the placenta

133
Q

in what trimester should you avoid the use of carbimazole?

A

1st trimester

134
Q

what trimester is it safer to use propylthiouracil than carbimazole?

A

1st trimester

135
Q

what is post partum thyroiditis?

A

transient hyperthyroxaemia 6 weeks after pregnancy which moves to hypothyroidism

136
Q

what are the 4 main causes of superficial swellings in the neck?

A
  • sebaceous cysts
  • lipoma
  • neurofibroma
  • carbuncle
137
Q

what are the 3 main causes of midlline swellings in the neck?

A
  • thyroid swelling
  • thyroglossal cyst
  • dermoid cyst
138
Q

what is the main infecting organism of a carbuncle?

A

staph

139
Q

what are the 4 main causes of anterior triangle swellings in the neck?

A
  • lymph nodes
  • branchial cysts
  • salivary glands
  • carotid body tumour
140
Q

what are the 2 main causes of posterior triangle swellings in the neck?

A
  • lymph nodes

- cystic hygroma

141
Q

what is the embryological origin of a carbuncle (superficial swelling of the neck)? [endoderm, mesoderm or ectoderm]

A

ectoderm

142
Q

what is the embryological origin of a cystic hygroma (posterior triangle swelling of the neck)? [endoderm, mesoderm or ectoderm]

A

mesoderm

143
Q

what is the embryological origin of a dermoid cyst (midline swelling of the neck)? [endoderm, mesoderm or ectoderm]

A

ectoderm

144
Q

what is the embryological origin of a branchial cyst (anterior triangle swelling of the neck)? [endoderm, mesoderm or ectoderm]

A

mesoderm

145
Q

what is the embryological origin of the thyroid (midline structure of the neck)? [endoderm, mesoderm or ectoderm]

A

endoderm

146
Q

what is the embryological origin of a thyroglossal cyst (midline swelling of the neck)? [endoderm, mesoderm or ectoderm]

A

endoderm

147
Q

what is the embryological origin of a neurofibroma (superficial swelling of the neck)? [endoderm, mesoderm or ectoderm]

A

ectoderm

148
Q

when examining a neck lump what 6 features are you looking for?

A
  • position
  • size
  • shape
  • consistency
  • mobility
  • associated lymphadenopathy
149
Q

what test is done to screen for congenital thyroid disease?

A

guthrie test

150
Q

when is the guthrie test performed?

A

day 5

151
Q

what hormone levels are measured by the guthrie screening test?

A

TSH

T4

152
Q

does vit D increase or prevent loss of calcium from the kidney?

A

prevents loss

153
Q

does vit D increase or prevent calcium uptake from the gut?

A

increases uptake

154
Q

what type of receptor is the calcium sensor receptor?

A

g protein coupled receptor

155
Q

what does calcium binding to the calcium sensor receptor do to the levels of PTH?

A

suppresses PTH

156
Q

what is the function of PTH?

A

increases serum calcium by

  1. increasing gut absorption
  2. increasing resorption from bones
  3. increases reabsorption from the kidneys
157
Q

what does vit D do to PTH?

A

suppresses PTH

158
Q

if there is hypercalcaemia with suppressed PTH what does this indicate?

A

bone pathology

159
Q

if there is hypercalcaemia with normal or high PTH what is the next test you should do?

A

urine calcium levels

160
Q

if there is hypercalcaemia with normal or high PTH and high urine calcium, what does this indicate?

A

primary or tertiary hyperparathyroidism

161
Q

if there is hypercalcaemia with normal or high PTH and low urine calcium, what does this indicate?

A

familial hypocalciuric hypercalcaemia

162
Q

what are the 2 main causes of hypercalcaemia?

A

primary hyperparathyroidism

malignancy

163
Q

what is primary hyperparathyroidism?

A

overactive parathyroid glands: PTH is produced irrespective of calcium levels

164
Q

why does hyperparathyroidism cause osteopenia and increased risk of bone fractures?

A

high PTH causes high resorption of calcium from bones

165
Q

what imaging can be used to detect which of the parathyroid glands is overactive?

A

sestamibi scan

166
Q

what is secondary parathyroidism?

A

physiological high PTH in response to low calcium

167
Q

what is tertiary hyperparathyroidism?

A

parathyroid becomes autonomously overactive after many years of secondary parathyroidism

168
Q

which MEN type are parathyroid neoplasms associated with?

A

both 1 and 2

169
Q

what type of inheritence is familial hypocalciuric hypercalcaemia?

A

autosomal dominant

170
Q

what does familial hypocalciuric hypercalcaemia do to calcium sensing receptor?

A

makes it slightly insensitive

more calcium is needed for PTH suppression

171
Q

what are the main 3 causes of hypocalcaemia?

A

hypoparathyroidism
vit D deficiency
chronic renal failure

172
Q

compare intracellular and extracellular concentrations of calcium in a patient with hypomagnaseaemia?

A

intracellular Ca is high

extracellular Ca is low

173
Q

what is pseudohypoparathyroidism?

A

a genetic defect causing PTH resistance

174
Q

what are the levels of PTH in pseudohypoparathryoidism?

A

high

175
Q

what is pseudo-pseudohypoparathyroidism?

A

a genetic defect causing PTH resistance

calcium is normal because PTH is high

176
Q

compare calcium levels in a patient with pseudohypoparathyroidism and pseudo-pseudohypoparathyroidism?

A

pseudo- low calcium

pseudo-pseudo- normal calcium

Endocrine (5 decks)

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