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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
When would you start a patient on 25mg OD levothyroxine and build up? (3)
- CVD - >50yrs - Severe hypothyroidism
26
If your patient gets pregnant, how much must you increase the levothyroxine dose?
25-50mg
27
What is your target TSH for hypothyroidism management in someone who is pregnant?
TSH 0.5-1.5
28
What reduces levothyroxine absorption in the gut?
Iron and Calcium carbonate | Should be spaced by 4hrs
29
What is subclinical hypothyroidism?
Raised TSH Normal T3 and T4 No symptoms
30
What percentage of people with subclinical hypothyroidism progress to overt hypothyroidism per year?
2-5%
31
When should TFTs be reviewed in someone with subclinical hypothyroidism?
6 months
32
How might your management differ between with TSH <10 vs TSH >10?
TSH <10 = treatment is based on symptoms | TSH >10 = treat even if asymptomatic
33
How common is congenital hypothyroidism?
1:4000 births
34
How is congenital hypothyroidism diagnosed?
Screened on heel prick test
35
When is the heel prick test?
Day 5-7 of life
36
Why is congenital hypothyroidism on the heel prick test?
Must be treated within first 4wks of life
37
What are some features of congenital hypothyroidism? (5)
``` Prolonged neonatal jaundice Hypotonia Missing milestones Puffy face + macroglossia Short stature ```
38
What are some features of hyperthyroidism?
``` Weight loss Heat intolerance Palpitations Sweating Oligomenorrhoea Anxiety Tremor Diarrhoea ```
39
What are 3 causes of hyperthyroidism?
- Graves' - Toxic multinodular goitre - Drugs (Amiodarone)
40
Which 3 causes of HYPOthyroidism may cause HYPERthyroidism in their acute phase?
- Hashimoto's - Subacute thyroiditis (de Quervain's) - Postpartum
41
What 3 signs are specific for Grave's?
Eye signs - ophthalmoplegia + exophthalmos Pretibial myxoedema Thyroid acropachy
42
What is thyroid acropachy?
Triad of clubbing, hand and feet swelling, and new periosteal bone formation
43
What antibodies are positive in Graves'?
TRAB (90% +ve) | anti-TPO (75% +ve)
44
What is subacute (de Quervain's) thyroiditis?
Post-viral hyperthyroidism, progressing to hypothyroidism
45
What are the 4 phases (inc. duration) of subacute thyroiditis?
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
Which investigation may aid the diagnosis of subacute thyroiditis?
Thyroid scintography - shows reduced uptake globally (of Iodine-131)
47
What is the management of subacute thyroiditis?
Self-limiting NSAIDs for painful goitre Steroids in hypothyroidism develops
48
What is a thyroid storm?
Rare but life-threatening hyperthyroidism
49
What are some causes of a thyroid storm? (4)
Surgery Trauma Infection Acute iodine load eg. contrast media
50
What are the features of a thyroid storm?
``` Fever >38.5 Tachycardia Confusion Vomiting HTN (HF, jaundice) ```
51
What is the management of a thyroid storm?
``` Paracetamol IV propranolol IV Dexamethasone (4mg QDS) Antithyroid drugs Tx underlying cause ```
52
What proportion of people taking amiodarone develop thyroid problems?
1:6
53
How does amiodarone cause hypothyroidism?
High content of iodine -> Wolff-Chaikoff effect
54
What is the Wolff-Chaikoff effect? (amiodarone)
Thyroxine formation is inhibited due to high iodine concentration
55
Can you continue amiodarone if they develop HYPOthyroidism?
Yes, if you want, with levothyroxine replacement
56
What is Amiodarone-induced Thyrotoxicosis Type 1?
Excess iodine-induced thyroid hormone synthesis Causes goitre Mx = carbimazole
57
What is Amiodarone-induced Thyrotoxicosis Type 2?
Amiodarone-related destructive thyroiditis No goitre Mx = corticosteroids
58
Can you continue amiodarone if they develop HYPERthyroidism?
NO
59
What would a raised PTH and calcium with a low phosphate suggest?
Primary HYPERparathyroidism (PHPT)
60
What urine test can help dx primary HPT?
Urine calcium/creatinine clearance >0.01
61
What are the 3 main causes of PHPT?
- Solitary adenoma (80%) - Hyperplasia (15%) - Multiple adenoma (4%) - Parathyroid carcinoma (1%)
62
How does PHPT classically present?
Elderly female with unquenchable thirst + raised PTH
63
What are the symptoms of hypercalcaemia?
``` Bones - pain Stones - renal calculi Thrones - polyuria, constipation Groans - abdominal pain Moans - emotional changes ```
64
What is PHPT associated with? (2)
HTN | MEN I + II
65
What might XR show in PHPT?
Pepper-pot skull | Acro-osteolysis = osteopenia and erosion of terminal phalangeal tufts
66
What would PHPT blood tests show?
Raised PTH and calcium | Low phosphate
67
What is the DEFINITIVE management of PHPT?
Total parathyroidectomy
68
What are the indications for surgery in PHPT? (8)
- 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
When can conservative management be used for PHPT?
Calcium <0.25mg/dL above normal AND age >50yrs AND no end organ damage
70
What is the conservative management of PHPT?
Calcimimetics eg. cinacalcet
71
Where and why is PTH normally secreted?
Chief cells in parathyroid in response to low calcium
72
What is the action of PTH on bones?
Increase osteoclast activity -> increased bone reabsorption | Calcium and phosphate released into blood
73
What is the action of PTH on the kidneys?
Increased hydroxylation of vita in PCT | AND increased calcium reabsorption and phosphate excretion in DCT
74
What is the function of vitD?
Increases calcium absorption in small bowel due to increased expression of calcium-binding hormone
75
What is PTHrp?
PTH-related peptide Secreted by squamous cell bronchial carcinomas Causes hypercalcamia but cannot activate vitD
76
What would raised PTH and phosphate, with low calcium and vitD suggest?
Secondary HYPERparathyroidism (2 HPT)
77
What causes 2 HPT?
Parathyroid hyperplasia, secondary to low calcium | Almost always due to CKD -> low vitD
78
What are the symptoms of 2 HPT?
Not many | Eventually develop bone disease, osteitis fibrous cystica and soft tissue calcifications
79
What are two eponymous signs of hypocalcaemia?
Chvostek's and Trousseau
80
What is Trousseau's sign?
Flexion of wrist when BP cuff inflated
81
What is Chvostek's sign?
Twitching of facial muscles when tapping facial nerve anterior to ear
82
What is the management of 2 HPT?
Medical management eg. alfacalcidol (active vitD)
83
What are the indications for surgery in 2 HPT? (3)
- Bone pain - Persistent pruritus - Soft tissue calcifications
84
What is tertiary HPT?
Persistent raised PTH after correction of underlying cause of 2 HPT, due to hyperplasia of parathyroid
85
What is the management of tertiary HPT?
Allow 12m to see if settles (eg. post-kidney transplant) | If persistent, total parathyroidectomy with preimplantation of part of gland
86
What is the management of acute hypercalcaemia?
``` Saline - 1L 4hrly for 24hrs - 1L 6hrly for 48-72hrs IV pamidronate Furosemide to prevent overload ```

5th Year (8 decks)

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