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5th Year > Thyroid/Parathyroid > Flashcards

Thyroid/Parathyroid Flashcards

1
Q

What are the 6 causes of hypothyroidism?

A
  • Hashimoto’s
  • Subacute thyroiditis (de Quervain’s)
  • Riedel’s thyroiditis
  • Postpartum thyroiditis
  • Drugs (Lithium, Amiodarone)
  • Iodine deficiency
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2
Q

What is the most common cause of hypothyroidism?

A

Hashimoto’s

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3
Q

What are the 3 causes of hyperthyroidism?

A
  • Graves’
  • Toxic multi nodular goitre
  • Drugs (Amiodarone)
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4
Q

What is the most common cause of hyperthyroidism?

A

Graves’

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5
Q

What is a toxic multi nodular goitre?

A

Autonomously functioning nodules that secrete excess hormone

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6
Q

What happens to TSH and T4 in Graves’?

A

Low TSH

Raised T4

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7
Q

What happens to TSH and T4 in Hashimoto’s?

A

Raised TSH

Low T4

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8
Q

What is the important autoAb in Graves’?

A

TSH Receptor Ab (TRAB)

90-100%

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9
Q

What is the important autoAb in Hashimoto’s?

A

Anti-thyroid peroxidase Ab (anti-TPO)

90%

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10
Q

Which investigation will help dx a toxic multinodular goitre?

A

Nuclear Scintigraphy

Shows patchy uptake

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11
Q

What is the general Mx of hypothyroidism?

A

Levothyroxine replacement

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12
Q

What is the general Mx of hyperthyroidism?

A

Carbimazole suppression + Levothyroxine replacement
Propranolol for symptoms
(Radioiodine Tx)

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13
Q

How does Carbimazole work?

A

Blocks thyroid peroxidase (TPO) from iodinating tyrosine residues on thyroglobulin -> reduced thyroid hormone production

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14
Q

What is an important side effect of carbimazole?

A

Agranulocytosis

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15
Q

What are some symptoms of hypothyroidism?

A 
Weight gain
Lethargy
Cold intolerance
Dry skin/scalp
Non-pitting oedema
Constipation
Menorrhagia
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16
Q

What are the 6 PRIMARY causes of hypothyroidism?

A
  • Hashimoto’s
  • Subacute thyroiditis (de Quervain’s)
  • Riedel’s thyroiditis
  • Postpartum thyroiditis
  • Drugs (Lithium, Amiodarone)
  • Iodine deficiency
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17
Q

What could be a (rare) SECONDARY cause of hypothyroidism?

A

Pituitary failure

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18
Q

Which 2 syndromes are associated with hypothyroidism?

A

Down’s
Turner’s
(Coeliac disease)

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19
Q

What is Riedel’s thyroiditis?

A

Parenchyma replaced with fibrous tissue -> painless goitre

‘Thyroid cirrhosis’

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20
Q

Who get’s Riedel’s thyroiditis?

A

Middle-aged women with retroperitoneal fibrosis

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21
Q

What are the differentiating features of subacute hypothyroidism (de Quervain’s)?

A

Painful goitre and raised ESR

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22
Q

What is the management of hypothyroidism?

A

Levothyroxine 50-100mg OD

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23
Q

What TSH level are you aiming for when treating hypothyroidism?

A

TSH 0.5-2.5

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24
Q

When do you check the TFTs after starting hypothyroidism management?

A

TFT @ 8-12wks

Titrate dose

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25
Q

When would you start a patient on 25mg OD levothyroxine and build up? (3)

A
  • CVD
  • > 50yrs
  • Severe hypothyroidism
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26
Q

If your patient gets pregnant, how much must you increase the levothyroxine dose?

A

25-50mg

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27
Q

What is your target TSH for hypothyroidism management in someone who is pregnant?

A

TSH 0.5-1.5

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28
Q

What reduces levothyroxine absorption in the gut?

A

Iron and Calcium carbonate

Should be spaced by 4hrs

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29
Q

What is subclinical hypothyroidism?

A

Raised TSH
Normal T3 and T4
No symptoms

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30
Q

What percentage of people with subclinical hypothyroidism progress to overt hypothyroidism per year?

A

2-5%

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31
Q

When should TFTs be reviewed in someone with subclinical hypothyroidism?

A

6 months

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32
Q

How might your management differ between with TSH <10 vs TSH >10?

A

TSH <10 = treatment is based on symptoms

TSH >10 = treat even if asymptomatic

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33
Q

How common is congenital hypothyroidism?

A

1:4000 births

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34
Q

How is congenital hypothyroidism diagnosed?

A

Screened on heel prick test

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35
Q

When is the heel prick test?

A

Day 5-7 of life

36
Q

Why is congenital hypothyroidism on the heel prick test?

A

Must be treated within first 4wks of life

37
Q

What are some features of congenital hypothyroidism? (5)

A 
Prolonged neonatal jaundice
Hypotonia
Missing milestones
Puffy face + macroglossia
Short stature
38
Q

What are some features of hyperthyroidism?

A 
Weight loss
Heat intolerance
Palpitations
Sweating
Oligomenorrhoea
Anxiety
Tremor
Diarrhoea
39
Q

What are 3 causes of hyperthyroidism?

A
  • Graves’
  • Toxic multinodular goitre
  • Drugs (Amiodarone)
40
Q

Which 3 causes of HYPOthyroidism may cause HYPERthyroidism in their acute phase?

A
  • Hashimoto’s
  • Subacute thyroiditis (de Quervain’s)
  • Postpartum
41
Q

What 3 signs are specific for Grave’s?

A

Eye signs - ophthalmoplegia + exophthalmos
Pretibial myxoedema
Thyroid acropachy

42
Q

What is thyroid acropachy?

A

Triad of clubbing, hand and feet swelling, and new periosteal bone formation

43
Q

What antibodies are positive in Graves’?

A

TRAB (90% +ve)

anti-TPO (75% +ve)

44
Q

What is subacute (de Quervain’s) thyroiditis?

A

Post-viral hyperthyroidism, progressing to hypothyroidism

45
Q

What are the 4 phases (inc. duration) of subacute thyroiditis?

A

Phase 1 - hyperthyroidism, painful goitre, raised ESR (3-6wks)
Phase 2 - euthyroid (1-3wk)
Phase 3 - hypothyroidism (wks-months)
Phase 4 - back to normal

46
Q

Which investigation may aid the diagnosis of subacute thyroiditis?

A

Thyroid scintography - shows reduced uptake globally (of Iodine-131)

47
Q

What is the management of subacute thyroiditis?

A

Self-limiting
NSAIDs for painful goitre
Steroids in hypothyroidism develops

48
Q

What is a thyroid storm?

A

Rare but life-threatening hyperthyroidism

49
Q

What are some causes of a thyroid storm? (4)

A

Surgery
Trauma
Infection
Acute iodine load eg. contrast media

50
Q

What are the features of a thyroid storm?

A 
Fever >38.5
Tachycardia
Confusion
Vomiting
HTN
(HF, jaundice)
51
Q

What is the management of a thyroid storm?

A 
Paracetamol
IV propranolol
IV Dexamethasone (4mg QDS)
Antithyroid drugs
Tx underlying cause
52
Q

What proportion of people taking amiodarone develop thyroid problems?

A

1:6

53
Q

How does amiodarone cause hypothyroidism?

A

High content of iodine -> Wolff-Chaikoff effect

54
Q

What is the Wolff-Chaikoff effect? (amiodarone)

A

Thyroxine formation is inhibited due to high iodine concentration

55
Q

Can you continue amiodarone if they develop HYPOthyroidism?

A

Yes, if you want, with levothyroxine replacement

56
Q

What is Amiodarone-induced Thyrotoxicosis Type 1?

A

Excess iodine-induced thyroid hormone synthesis
Causes goitre
Mx = carbimazole

57
Q

What is Amiodarone-induced Thyrotoxicosis Type 2?

A

Amiodarone-related destructive thyroiditis
No goitre
Mx = corticosteroids

58
Q

Can you continue amiodarone if they develop HYPERthyroidism?

A

NO

59
Q

What would a raised PTH and calcium with a low phosphate suggest?

A

Primary HYPERparathyroidism (PHPT)

60
Q

What urine test can help dx primary HPT?

A

Urine calcium/creatinine clearance >0.01

61
Q

What are the 3 main causes of PHPT?

A
  • Solitary adenoma (80%)
  • Hyperplasia (15%)
  • Multiple adenoma (4%)
  • Parathyroid carcinoma (1%)
62
Q

How does PHPT classically present?

A

Elderly female with unquenchable thirst + raised PTH

63
Q

What are the symptoms of hypercalcaemia?

A 
Bones - pain
Stones - renal calculi
Thrones - polyuria, constipation
Groans - abdominal pain
Moans - emotional changes
64
Q

What is PHPT associated with? (2)

A

HTN

MEN I + II

65
Q

What might XR show in PHPT?

A

Pepper-pot skull

Acro-osteolysis = osteopenia and erosion of terminal phalangeal tufts

66
Q

What would PHPT blood tests show?

A

Raised PTH and calcium

Low phosphate

67
Q

What is the DEFINITIVE management of PHPT?

A

Total parathyroidectomy

68
Q

What are the indications for surgery in PHPT? (8)

A
  • Calcium >1mg/dL above normal
  • Hypercalciuria >400mg/day
  • Creatinine clearance <30% of normal
  • Life-threatening hypercalcaemia episode
  • Nephrolithiasis
  • Age <50yrs
  • Neuromuscular symptoms
  • T-score
69
Q

When can conservative management be used for PHPT?

A

Calcium <0.25mg/dL above normal
AND age >50yrs
AND no end organ damage

70
Q

What is the conservative management of PHPT?

A

Calcimimetics eg. cinacalcet

71
Q

Where and why is PTH normally secreted?

A

Chief cells in parathyroid in response to low calcium

72
Q

What is the action of PTH on bones?

A

Increase osteoclast activity -> increased bone reabsorption

Calcium and phosphate released into blood

73
Q

What is the action of PTH on the kidneys?

A

Increased hydroxylation of vita in PCT

AND increased calcium reabsorption and phosphate excretion in DCT

74
Q

What is the function of vitD?

A

Increases calcium absorption in small bowel due to increased expression of calcium-binding hormone

75
Q

What is PTHrp?

A

PTH-related peptide
Secreted by squamous cell bronchial carcinomas
Causes hypercalcamia but cannot activate vitD

76
Q

What would raised PTH and phosphate, with low calcium and vitD suggest?

A

Secondary HYPERparathyroidism (2 HPT)

77
Q

What causes 2 HPT?

A

Parathyroid hyperplasia, secondary to low calcium

Almost always due to CKD -> low vitD

78
Q

What are the symptoms of 2 HPT?

A

Not many

Eventually develop bone disease, osteitis fibrous cystica and soft tissue calcifications

79
Q

What are two eponymous signs of hypocalcaemia?

A

Chvostek’s and Trousseau

80
Q

What is Trousseau’s sign?

A

Flexion of wrist when BP cuff inflated

81
Q

What is Chvostek’s sign?

A

Twitching of facial muscles when tapping facial nerve anterior to ear

82
Q

What is the management of 2 HPT?

A

Medical management eg. alfacalcidol (active vitD)

83
Q

What are the indications for surgery in 2 HPT? (3)

A
  • Bone pain
  • Persistent pruritus
  • Soft tissue calcifications
84
Q

What is tertiary HPT?

A

Persistent raised PTH after correction of underlying cause of 2 HPT, due to hyperplasia of parathyroid

85
Q

What is the management of tertiary HPT?

A

Allow 12m to see if settles (eg. post-kidney transplant)

If persistent, total parathyroidectomy with preimplantation of part of gland

86
Q

What is the management of acute hypercalcaemia?

A 
Saline 
- 1L 4hrly for 24hrs
- 1L 6hrly for 48-72hrs
IV pamidronate
Furosemide to prevent overload

5th Year (8 decks)

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