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Endocrine > Thyroid & Parathyroid Disease > Flashcards

Thyroid & Parathyroid Disease Flashcards

1
Q

Primary disorders of the thyroid are of what origin?

A

The gland itself

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2
Q

All thyroid diseases are goitrous, true or false?

A

False

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3
Q

TSH is released by which cells & where?

A

Thyrotroph cells in the anterior pituitary

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4
Q

T4/T3 represents the majority of thyroid hormone produced?

A

T4 (80%) AKA “thyroxine”

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5
Q

What are the thyroid-binding plasma proteins? (3)

A

1) TBG
2) TTR
3) Albumin

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6
Q

True/false: fT3 is the active form of thyroid hormone?

A

True

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7
Q

T4 or T3 influences a negative feedback loop?

A

T3

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8
Q

Where is T4 principally converted to T3?

A

Liver

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9
Q

In primary hypothyroidism, free T3/T4 is what? What is TSH?

A

Free T3/T4 = low

TSH is high

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10
Q

In secondary hyperparathyrodism, the free T3/T4 is what & what is the TSH?

A

T3/T4 is high

TSH is inappropriately high or normal

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11
Q

What’s the clinical term for a severe hypothyroid emergency?

A

Myxoedema

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12
Q

What’s the rare classical skin sign for Graves’ disease?

A

Pretibial myxodema

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13
Q

What is the TSH and thyroxine profile in subclinical hypothyrodisim?

A

Thyroxine is just borderline normal while TSH i shigh

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14
Q

Hypothyroidism is more common in African populations than whites? true or false?

A

False

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15
Q

Iodine uptake positively or negatively correlates with thyroid disease?

A

Positively (more common in higher uptake areas)

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16
Q

Hashimoto’s thyroiditis is a condition of hypo/hyper-thyroidism? Does it usually cause goitre?

A

Hypothyroidism & yes goitre present (if not it’s termed atrophic thyroiditis)

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17
Q

Iodine deficiency usually induces a goitrous/non-goitrous form of thyroid disease?

A

Goitrous

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18
Q

Name 2 drugs which can cause a goitrous hypothyroidism

A
  • Amiodarone

- Lithium

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19
Q

Atrophic thyroiditis is another term for what

A

Hashimoto’s thyroidits WITHOUT goitre

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20
Q

The most common cause of hypothyroidism in the west is…

A

Autoimmune hypothyroidism (e.g. Hashimoto’s or atrophic thyroiditis)

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21
Q

Hypothyroidism is more common in women/men?

A

Women

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22
Q

What are the defining traits of autoimmune hypothyroidism? (2)

A

1) Antibodies against TPO

2) T-cell infiltrate of thyroid

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23
Q

List the main features of hypothyroidism (8)

A

1) Coarse, sparse hair
2) Dull, expressionless face
3) Reduced thermogenesis leading to cold intolerance
4) Cardiac dilation
5) Reduced HR
6) Metabolic hyperlipidaemia (xanthelasma)
7) Decrease in appetite but weight gain
8) Megacolon

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24
Q

What neurological signs are associated with hypothyroidism? (3)

A

1) Decreased intellect and motor activity
2) Depression, psychosis
3) Carpal tunnel syndrome

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25
Q

Hypothyroidism has no influence on reproduction, true or false?

A

False - causes painful period, can cause hyperprolactinaemia (excess TRH leads to excess PRL)

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26
Q

The cardinal abnormalities in hypothyroidism are (2)

A

1) Elevated TSH

2) Reduced fT4/T3

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27
Q

Hyponatremia is present in hypothyroidism, true or false?

A

True (but rare)

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28
Q

Macrocytosis is a feature of hypothyroidism, true or false?

A

True

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29
Q

TRAb antibodies are present in which % of Graves’ cases?

A

70-100%

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30
Q

Anti-TPO antibodies are present in which % of autoimmune hypothyroid cases?

A

95%

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31
Q

Which type of respiratory failure is common in myoxedma coma?

A

Type 2 (hypoxaemia with hypercapnia)

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32
Q

Myxoedema coma is a complication of longstanding untreated hypothyroidism. How fatal is it with treatment?

A

60%

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33
Q

How should myoxedema coma be treated (3)?

A

1) Passive warming
2) Broad-spectrum antibiotics
3) Thyroxine cautiously (but NOT if adrenal failure is present)

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34
Q

Thyrotoxicosis is the condition occurring when tissues are exposed to…

A

Excessive thyroid hormone

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35
Q

List the major clinical signs & symptoms of thyrotoxicosis (cardiac, sympathetic, GI, vision, repro, muscles, metabolism)

A

-Cardiac (AF, palpitations)
-Sympathetic (tremor, sweating)
-GI (frequent, loose stools)
Vision (lid retraction, proptosis)
-Repro (lighter bleeding and less frequent periods)
-Muscles (proximal weakness)
-Metabolism (intolerance to heat, weight loss)

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36
Q

Hashitoxicosis refers mostly to what presentation of Hashimoto’s?

A

The initial presentation, which can give rise to transient hyperthyroidism before hypothyroidism

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37
Q

Thyrotoxicosis is always associated with hyperthyroidism, true or false?

A

False

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38
Q

DeQuervain’s Thyroiditis is a condition of resulting from what factor?

A

X = thyrotoxicosis

Resulting from viral infection. Often self-limiting - but can indicate progression

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39
Q

Thyroiditis may be caused by amiodarone, true or false?

A

True

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40
Q

Thyrotoxicosis factitia describes what clinical case?

A

Self or deliberate poisoning

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41
Q

Struma ovarii is a condition of what

A

Ovary teratoma containing thyroid tissue

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42
Q

Overtreatment of levothyroxine can lead to thyrotoxicosis, true or false?

A

True

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43
Q

What % of HLA genes determines the risk of developing Graves?

A

70%

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44
Q

The cardinal abnormalities of Graves (biochemistry)

A

Low TSH, high fT4/T3

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45
Q

Hypercalcaemia is present in Graves, true or false?

A

True - it’s a cause of osteoporosis

46
Q

Thyroid acropachy is a sign of which condition?

A

Graves’ Disease

47
Q

What’s a goitre sign specific to Graves?

A

Thyroid bruit

48
Q

Graves’ goitre is always bilateral, true or false?

A

False - can be unilateral

49
Q

Nodular thyroid goitre tends to be symmetrical, true or false?

A

False

50
Q

Thyroid storm is a medical emergency characterised by…

A

Severe untreated hyperthyroidism

51
Q

The end-stage manifestation of thyrotoxicosis is…

A

Thyroid storm

52
Q

How is thyroid storm treated (4)

A

1) Lugol’s iodine
2) Steroids
3) PTU
4) Beta-blockers

53
Q

What’s the 1st line treatment for nodular thyroid disease & relapsing Graves?

A

Radioiodine

54
Q

Radiodine increases risk of thyroid cancer, true or false?

A

False

55
Q

Radiodine is contraindicated in (2)

A

Pregnancy & active thyroid disease

56
Q

Which nerve is at risk in thyroidectomy?

A

Recurrent laryngeal

57
Q

Sub-acute thyroiditis usually progresses to clinical disease, true or false?

A

False - usually self-limiting

58
Q

Subclinical hypothyroidism does not need to be treated in pregnancy, true or false?

A

False

59
Q

What’s the biochemical profile of subclinical hyperthyroidism?(2)

A

Low TSH, normal fT4/T3

60
Q

Subclinical thyroiditis is assoicated with which 2 conditions?

A

Osteoporosis, AF

61
Q

Amiodarone only induces hypothyroidism, true or false?

A

False - can cause hyperthyroidism as well

62
Q

Amiodarone works how?

A

Inhibiting DIO1

63
Q

Sick euthyroid syndrome is a rare/common condition in the acutely unwell. It generally needs treated, true or false?

A

Common - does not often need treatment

64
Q

Spot diagnosis:

  • 68 year old female
  • TATT, weight gain, goitre, slowness.
  • Lab results: high TSH, fT4 low.
  • DX: ?
A

-DX: Primary hypothyroidism

65
Q

Spot diagnosis:

  • 68 year old female
  • TATT, goitre. FH of thyroid disease.
  • Lab results: TSH high, fT4 normal, TPO antibodies present.
  • DX: ?
A

-DX: Subclinical hypothyroidism (as fT4 is normal but TSH is high)

66
Q

Spot diagnosis:

  • 52 year old male
  • Headache, visual field defect, dizziness, poor libido.
  • Lab results: TSH low, fT4 low.
  • DX: ?
A

-DX: Secondary hypothyroidism (secondary to a pituitary tumour - notice the lack of sexual characteristics)

67
Q

Spot diagnosis:

  • 32 year old female
  • Weight loss, tremor, TATT, sleep disturbance.
  • Lab results: TSH very low, fT4 very high.
  • DX: ?
A

-DX: Graves Disease (not secondary as the TSH would be high in this case, indicating the gland is working)

68
Q

Spot diagnosis:

  • 70 year old female.
  • Diagnosed with AF
  • No symptoms
  • Lab results: TSH low, fT4 high.
  • DX: ?
A

-DX: Toxic multi-nodular goitre (associated with AF, TSH will be low but the nodules keep producing T4)

69
Q

Spot diagnosis:

  • 32 year old female.
  • Sore throat & febrile illness. Weight loss, poor sleep.
  • Lab results: TSH low, fT4 high.
  • Six weeks later lab results change to TSH high, fT4 low.
  • DX: ?
A

-DX: Subacute thyroiditis (DeQuervain’s; can present with initial hyperthyroidism then transient hypothyroidism).

70
Q

Principle symptoms of hypothyroidism (4)

A

1) Reduced BMR, puts on weight easy
2) Slow pulse
3) Fatigue, lethargy
4) Cold intolerance

71
Q

In adults, hypothyroidism may lead to…

A

Myxoedema (puffy facial appearance)

72
Q

Principle symptoms of hyperthyroidism (5)

A

1) increased BMR
2) Very fast pulse
3) Emotional lability
4) Sweating & heat intolerance
5) Exopthalmos

73
Q

Which 3 signs are specific to Graves’ disease?

A

1) Thyroid bruits
2) Pretibial myxoedema
3) Thyroid acropachy

74
Q

Lactotroph cells (LH secretors) are under short/long-loop control & what’s the mechanism of feedback?

A

Short loop negative feedback w/ dopamine

75
Q

IGF-1 works on which organ?

A

Liver

76
Q

No / low cortisol leads to an…

A

Addisonian Crisis

77
Q

Cabergoline is what kind of drug & what is it used to treat?

A

Dopamine agonist - used to treat prolactinoma

78
Q

Prolactinomas often require surgical excision, T/F?

A

False - drugs like cabergoline (dopamine agonists) usually control it well

79
Q

Hypothyroidism can be a cause of raised prolactin, T/F?

A

True

80
Q

Hypertension is an important feature of acromegaly, T/F?

A

True

81
Q

The headache in acromegaly is usually treatable with drugs, T/F?

A

False - it’s vascular in origin

82
Q

Acromegaly is diagnosed using which test?

A

OGTT (looks for IGF-1, which should be suppressed as GH is a counter-regulatory hormone which is released in hypoglycaemia)

83
Q

The first-line therapy for acromegaly is surgical/medical?

A

Surgical

84
Q

Medical therapies for acromegaly include (3)

A

1) Dopamine agonists (cabergoline)
2) Somatostatin analogues (octreotide) - advantageous as they also treat headache
3) GH antagonist (Pegvisomant)

85
Q

Pegvisomant (a GH-receptor antagonist) reduces tumour size, T/F?

A

False

86
Q

Side-effects of somatostatin analogues include (3)

A

1) Local stinging
2) Flatulence
3) Diarrhoea

87
Q

What drug can be used pre-operatively to improve outcome in GH-tumour surgery?

A

Somatostatin analogue (e.g. sandostatin) as they will reduce the tumour size

88
Q

Common causes of hypocalcaemia (3)

A

Hypoparathyroidism, vitamin D deficiency, pseudohypopoarathyroidism

89
Q

What is psuedohypoparathyroidism?

A

A mutation in GNAS causing a peripheral resistance to parathyroid hormone, giving elevated PTH

90
Q

What is psuedo-psuedo-hypoparathyroidism?

A

Mutation in GNAS gene (AD) causing lack of peripheral action of PTH, but no resistance (unlike 1 psuedo) - often with normal calcium

91
Q

Describe “CATS go numb” in hypocalcaemia

A 
Convulsions
Arrhythmia
Tetany
Spasms
Numbness
92
Q

All hypocalcaemia should be treated with IV calcium, T/F?

A

False - only severe. Mild/moderate can be treated with calcium supplements

93
Q

What effect does PTH have? (3)

A

1) Bone resorption
2) Decreased calcium loss in urine
3) Enhanced calcium absorption from GI tract

94
Q

Where does vitamin D production occur? (3)

A

Skin, liver and kidney

95
Q

Where does the final step of vitamin D production occur?

A

Kidney

96
Q

Which form of vitamin D is made by the kidney?

A

1, 25-OH vitamin D

97
Q

What are the symptoms of hypercalcaemia?

A

Fractures (osteitis fibrosa cystica), renal stones, pancreatitis (and nausea& vomiting) and depression.

Painful Bones, Renal Stones, Abdominal Groans and Psychic Moans

98
Q

What’s the primary investigation for hyperglycaemia?

A

ALK-P (if high suggests bony mets, if low myeloma)

99
Q

Causes of hypercalcaemia include (3)

A

Primary hyperparathyroidism, malignancy, certain drugs (e.g. Vitamin D, thiazides)

100
Q

Treatment of acute hyperglycaemia is with (2)

A

1) Fluids and ONCE rehydrated 2) loop diuretics (not thiazides)

101
Q

How long do bisphosphonates take to work & what condition are they useful in?

A

1 week and hypercalcaemia

102
Q

Primary hypercalcaemia is often medically managed, T/F?

A

False - usually surgical excision required

103
Q

Secondary hyperparathyroidism is a response to…

A

Low calcium (a physiological)

104
Q

Tertiary hyperparathyroidism develops due to

A

Multiple years of secondary (parathyroid becomes autonomous)

105
Q

If patient is hypercalcaemic & albumin is raised, what is the likely diagnosis?

A

Dehydration

106
Q

Cinacalcet is useful in which condition?

A

Tertiary hyperparathyroidism

107
Q

Hypocalciuric hypocalcaemia is inherited how? What’s the defect?

A

AD and a defect in the calcium sensor (often benign & incidental)

108
Q

Is calcium elevated in Paget’s? What about PTH?

A

No (only ALK-P is elevated)

109
Q

Looser’s Zones is a classical X-ray sign of what disease?

A

Osteomalacia

110
Q

Vitamin-D resistant Rickets is a genetic condition with which association?

A

X-linked hypophosphataemia (due to PHEX / FGF23 gene mutation)

111
Q

FGF23 is secreted by which cell?

A

Osteocyte

Endocrine (17 decks)

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