Thyroid Passmed Qs Flashcards
De Quervain’s thyroiditis AKA
Subacute thyroiditis
DQ thyroiditis during thyroid scintigraphy
Globally reduced uptake of iodine
Sick euthyroid syndrome
Caused by systemic illness
Low total + free T4/3 (levels only mildly below normal)
Normal TSH
Increased TSH
Normal T4
Subclinical hypothyroidism
Papillary thyroid cancer
65% Young females Metastasis to cervical lymph nodes Thyroglobulin used as tumour marker Orphan Annie eyes on light microscopy Good prognosis
Follicular thyroid cancer
20% Generally women > 50 Metastasis to lung and bones Thyroglobulin can be used as tumour marker Moderate prognosis
Medullary thyroid cancer
5%
Sporadic or part of MEN2 syndrome
Originates from parafollicular cells which produce calcitonin
Calcitonin can be used as tumour marker
Anaplastic thyroid cancer
V rare
Elderly
Poor prognosis
Lymphoma
5%
Dysphagia or stridor
MEN 1
Pituitary adenoma
Parathyroid hyperplasia (leading to hyperparathyroidism)
Pancreatic tumours- insulinoma, gastrinoma
MEN 2A
Parathyroid hyperplasia
Medullary thyroid carcinoma
Phaeochromocytoma
MEN 2B
Mucosal neuroma
Marfanoid appearance
Medullary thyroid carcinoma
Phaeochromocytoma
Hashimoto’s thyroiditis clinical features
Hypothyroidism
Goitre
Anti-TPO
Toxic multi nodular goitre treatment
Radioactive iodine treatment of choice
DQ thyroiditis presentation
Thought to occur after viral infection Typically presents with hyperthyroidism Painful goitre Raised ESR Reduced iodine 131 uptake on scan
Thyrotoxicosis with tender goitre
Subacute (DQ) thyroiditis
Secondary hypothyroidism
Low TSH
Low T4
–> do MRI of gland
Grave’s + eye symptoms
Doesn’t need to have eye symptoms to be graves
Low thyroxine compliance
If don’t take thyroxine, High TSH and low T4- often patients over compensate before appointment, leading to an increase in T4 without enough time for TSH to be compressed (days/weeks)
–> High TSH and High T4
Subclinical hypothyroidism in elderly
Watch and wait
Carbimazole + agranulocytosis
ESR test needs to be done
Warn of sore throat
Toxic adenoma
Low TSH
Hot solitary nodule
Hyperthyroidism + period
Associated with oligomenorrhea
Subacute thyroiditis
Causes hyper then hypothyroidism
Thyrotoxic storm treatment
Beta blockers
Propylthiouracil
Hydrocortisone
Myxoedemic coma
Hypothermia
Hyporeflexia
Bradycardia
Seizures
Myxoedemic coma treatment
Thyroxine
Hydrocortisone
Iron + thyroxine
Iron reduces its absorption
Graves autoantibodies
TSH receptor stimulating antibodies (90%)
Anti-thyroid peroxidase antibodies (75%)
Changes in vision with thyroid eye disease
Urgent review by specialist
Subclinical hypothyroidism
Normal T3
High TSH
If TSH between 4-10: Below 65 give levothyroxine, above 65 watch and wait, if asymptomatic observe + repeat TFTs 6 months
If TSH above 10- Below 70 start thyroxine
Subclinical hyperthyroidism
Normal T3
Low TSH
Causes- multinodular goitre, excessive thyroxine
Effects CVS (AF), Osteoporosis
Increased risk dementia
Give low dose anti-thyroid drugs for 6 months
Hypothyroidism electrolyte
Decreased Na
Hyperthyroidism electrolyte
Increased Ca
Hypothyroidism + periods
Menorrhagia
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