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Endocrine > Thyroid Pathology > Flashcards

Thyroid Pathology Flashcards

1
Q

what is the most common cause of hyperthyroidism

A

Graves disease

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2
Q

what is graves disease

A

autoimmune destruction of the thyroid gland, commonly affects middle aged women

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3
Q

which autoantibodies are positive in Graves disease

A

TRAb

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4
Q

describe the goitre in Graves disease

A

smooth goitre

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5
Q

list some other causes of hyperthyroidism

A

drug induced - lithium, amiodarone
nodular - TRAb -ve and asymmetrical goitre
post viral hyperthyroidism

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6
Q

what is the indication that a lump in the throat is a goitre

A

moves superiorly on swallowing

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7
Q

what are the symptoms and signs of hyperthyroidism

A

diarrhoea, light periods, tremor, palpitations, heat intolerance, weight loss, anxiety, visible goitre

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8
Q

what are the eye manifestations of Graves disease

A

chemosis - swelling of conjunctiva
proptosis
double vision
gritty eyes

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9
Q

what is pre-tibial myxoedema

A

pitting oedema found in the shins, seen with graves disease

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10
Q

describe TFTs for primary, secondary and sub-clinical hyperthyroidism

A

primary - T3/T4 high and TSH low
secondary - T3/T4 high and TSH high
sub-clinical - t3/t4 normal and TSH high

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11
Q

list the first and second line anti-thyroid drugs

A

carbimazole first line and propylthiouracil second line

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12
Q

what other drugs are used to treat hyperthyroidism

A

symptom management eg propanolol and anti-motility drugs

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13
Q

list the side effects of anti-thyroid drugs

A

carbimazole not safe during first trimester of pregnancy and risk of agranulocytosis - must stop medication if experience extreme fever and mouth ulcers

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14
Q

what are the other methods of treatment for hyperthyroidism other than drugs

A

radio-ablation

thyroidectomy but risk of hypothyroidism and hypoparathyroidism

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15
Q

what is thyrotoxicosis

A

severe form of hyperthyroidism

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16
Q

what causes thyrotoxicosis

A

infection, MI, recent thyroid surgery

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17
Q

how does thyrotoxicosis present

A

confusion, tachycardia, AF, diarrhoea, thyroid bruit and risk of circulatory collapse

18
Q

outline the management of thyrotoxicosis

A

fluids
beta-blocker or digoxin
carbimazole

19
Q

hypothyroidism has higher incidence in area of high or low iodine

A

high iodine

20
Q

list the different causes of hypothyroidism

A

Hashimotos - autoimmune

iatrogenic such as post thyroidectomy or drug induced

21
Q

what is the presentation of Hashimotos thyroiditis specifically

A

autoimmune destruction with goitre
presents in women aged 40-60
presentation of thyroid perioxidase antibodies

22
Q

list the symptoms of hypothyroidism

A

constipation, cold tolerance, depression, weight gain, bradycardia, dry skin and hair, heavy periods, peri-orbital swelling and cognitive impairment

23
Q

describe TFTs for primary, secondary and sub-clinical hypothyroidism

A

primary - T3/T4 low and TSH high
secondary - T3/T4 low and TSH low
sub-clinical - T3/T4 normal and TSH high

24
Q

what is the management for hypothyroidism

A

levothyroxine - synthetic T4

25
Q

what is the dosing of levothyroxine

A

young patient - 50-100 mcg

older patient or high risk IHD - 25-50 mcg

26
Q

what is the severe form of hypothyroidism that occurs if untreated or following surgery

A

myxoedema coma

27
Q

how does myxoedema coma present

A

psychosis
seizures
coma
hypothermia and hypoglycaemia

28
Q

how is myxoedema coma managed

A

correct hypoglycaemia
warm patient
T3 infusion
hydrocortisone

29
Q

what increases risk of developing thyroid cancer

A

radiation exposure

30
Q

how does thyroid cancer present

A

enlarging lump on the thyroid or goitre
dysphagia or SOB
facial swelling if superior vena cava obstruction

31
Q

what do TFTs look like with thyroid cancer

A

usually normal, especially if well-differentiated

32
Q

what is the gold standard investigation for diagnosing thyroid cancer

A

ultra-sound guided fine needle aspiration

33
Q

what is the most common type of thyroid cancer and how does it spread

A

papillary cancer, spreads via lymphatics

presents aged 20-30 with good prognosis

34
Q

what is the second most common type of thyroid cancer and how does it spread

A

follicular - spreads haematologically

well differentiated cancer with good prognosis

35
Q

which cancer has the poorest prognosis and how does it present

A

anaplastic thyroid cancer, hard, craggy growth on the neck usually presents in elderly
very rapid growth with haematoglogical spread

36
Q

thyroid lymphoma is associated with what disease

A

autoimmune thyroid diseases such as Hasimotos thyroiditis

requires chemo/radiation to treat

37
Q

define a low risk thyroid tumour

A

<50 years old, tumour <4cm, well-differentiated and TSH low range of normal

38
Q

what is the management of thyroid tumours

A

thyroidectomy

radio-ablation if hyperthyroid

39
Q

radio-ablation increases risk of what cancer

A

acute myeloid leukaemia

40
Q

when does T3 and T4 need to be stopped for radio-ablation

A

T3 - 2 weeks prior

T4 - 4 weeks prior

Endocrine (11 decks)

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