Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endocrine > Thyroid Pathology > Flashcards

Thyroid Pathology Flashcards

1
Q

What is the function of thyroid hormone?

A

>Cell Basal Metabolic Rate

>CO

>Bone Resorption

Activates sympathetic nervous system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What hormone is thyroid hormone permissive to?

A

Adrenalin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the pathophysiology of Grave’s disease

A

Antibodies are produced which mimic TSH and continually activates the thyroid gland

This increased TH production switches off TSH release and so plasma concentration is low

Thyroid gland may be 2-3X normal size due to hyperplasia and hyperactive cells may also be apparent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What sex is hyperthyroidism more common?

A

F>M

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the causes of hyperthyroidism?

A

Graves

Thyroid Adenoma

Toxic Multinodular Goitre

Secondary: Pituitary adenoma

Drugs

Struma Ovarii: Rare ovarian cancer

(Initial De Quervain’s)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What drugs can cause hyperthyroidism?

A

Amiodarone

Lithium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most common cause of hyperthyroidism?

A

Graves (70% causes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does hyperthyroidism present?

A

Tremor

Weight loss

Palpitations

Hair loss

Poor concentration

Amenorrhea/oligomennnorhoea

Bowel frequency

Sweaty

Heat Intolerance

Exophthalmos/Proptosis

Pretibial myxoedema

Muscle weakness

Clubbing

Anxiety/irritability

Hyperreflexia

>HR/Tachycardia

Goitre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a goitre?

A

Enlargement of the thyroid gland that can accompany hypo and hyperthyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What investigations are used in hyperthyroidism diagnosis?

A

TSH

Increased unbound T3/T4

Radioactive Iodine Uptake Test and Thyroid Scan

  • Patchy uptake suggests toxic multinodular goitre

Antibodies

  • Thyroid Peroxidase Antibodies
  • TSH Receptor Antibodies, present in 90-100% Graves patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When is TSH high for hyperthyroidism?

A

Secondary/pituitary causes of hyperthyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When is TSH low for hyperthyroidism?

A

Primary causes of hyperthyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Give complications of hyperthyroidism

A

Atrial fibrillation

HF

Osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is hyperthyroidism managed?

A

Anti-thyroid drugs

Radio-iodine therapy: For patients >45

Partial thyroidectomy

B-Blockers: Symptomatic relief

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Give an example of an anti-thyroid drug?

A

Carbimazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is thyroid storm?

A

Hypermetabolism when individual causing exacerbation of symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe the pathophysiology of Hashimoto’s

A

Autoimmune destruction of thyroid epithelial cells, involving T cells, cytokine and antibody mediated destruction (circulating antibodies to thyroglobulin and thyroid peroxidase)

This results in diffuse enlargement of the thyroid and then the eventual shrinkage and gradual failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How common is hypothyroidism?

A

Most common endocrine condition after diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What sex is hypothyroidism most common?

A

F>M

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the primary causes of hypothyroidism?

A

Hashimoto’s Disease

Deficiency in dietary iodine

  • Milk, seafood, seaweed

Iatrogenic

  • External radiation
  • Post-operative/post-radioactive iodine

Congenital

Post-subacute Thyroiditis/De Quervain’s

  • Post-infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is Hashimoto’s disease?

A

Autoimmune attack of thyroid gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the secondary causes of hypothyroidism?

A

Pituitary tumour

Craniopharyngioma

Post pituitary surgery or radiotherapy

Sheehan’s Syndrome

Isolated TRH Deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is Sheehan’s Syndrome?

A

Postpartum pituitary gland necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How does hypothyroidism present?

A

Weight gain

Cold intolerance

Depression

Dry and thin hair/skin, brittle nails: Disrupted protein synthesis

Constipation

Menorrhagia

Hoarseness: Severe

Lethargy

Hyporeflexia: Altered nervous system

Bradycardia

Goitre: If Hashimoto

Puffy face, large tongue: Severe

Coma: Severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What investigations are used in hypothyroidism diagnosis?

A

TSH

Anti Thyroid Peroxidase antibodies

FBC

  • Macrocytic anaemia

>ESR in De Quervain’s

Iodine uptake scan

  • Reduced iodine uptake in De Quervain’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When is TSH high for hypothyroidism?

A

Primary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When is TSH low/normal for hypothyroidism?

A

secondary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How is hypothyroidism managed?

A

Levothyroxine: T4 tablets

Liothyronine: T3 tablets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

When is subclinical hypothyroidism treated?

A

Treat if TSH>10 or >5 with positive thyroid antibodies

Trial therapy if TSH elevated with symptoms

30
Q

What is Myxoedema Coma?

A

Severe life-threatening form of hypothyroidism affecting those with poorly controlled hypothyroidism in a physiological stressful situation

31
Q

Describe how levothyroxine is given

A

T4 tablets, initial dose of 50cmg/day

Increase after 2 weeks to 100mcg and continue until TSH is normal

32
Q

What are the classifications of thyroid tumour?

A

Papillary carcinoma

Follicular carcinoma

Anaplastic carcinoma

Medullary carcinoma

Lymphoma

33
Q

What is the most common thyroid tumour?

A

Papillary carcinoma, most common at 75-80%

34
Q

Give side effects of Carbimazole

A

Agranulocytosis

Hair loss

Headaches

Nausea

Stomach pains

Itchy skin

Rashes

Muscle and joint pain

35
Q

What is the most serious side effect of Carbimazole?

A

Bone marrow suppression (neutropenia/agranulocytosis) resulting in immune system suppression

Sore throat is the most common symptom of this

36
Q

What is the mechanism of action of Carbimazole?

A

Blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin, therefore reducing thyroid hormone production

37
Q

How is Carbimazole given?

A

High doses for 6 weeks until patient becomes euthyroid before being reduced

38
Q

What group of patients is papillary carcinoma most common in?

A

Young females

39
Q

What is the prognosis of papillary carcinoma?

A

Excellent

40
Q

What is associated with medullary carcinoma?

A

MEN2

41
Q

What does medullary carcinoma secrete?

A

Calcitonin

This used as an alternative to thyroglobulin in medullary carcinoma for recurrence screening

42
Q

How are thyroid tumours managed?

A

Total thyroidectomy followed by radioiodine

43
Q

What histological sign is seen in papillary thyroid cancer?

A

Orphan annie cells

44
Q

What levels are measured yearly to detect early recurring thyroid tumours?

A

Thyroglobulin

45
Q

What sign is only seen in Graves disease?

A

Exopthalamos/Proptosis

46
Q

Give complications of Hashimotos

A

MALT Lymphoma

Addisons

Graves

Type 1 diabetes

Pernicious anaemia

Lupus Erythematosus

RA

Thrombocytopenic Purpura

Vitiligo

47
Q

How do thyroid tumours present?

A

PAID DUET

Pain in the neck

Asymmetry in the thyroid

Increased risk for women

Difficulty swallowing

Dyspnoea

Unexplained hoarseness

Enlarged lymph nodes in neck

Thyroid nodule/lump

48
Q

Can Carbimazole be used in pregnancy?

A

Contraindicated in first trimester as can cross placenta and cause aplasia cutis

49
Q

How does myxoedema coma present?

A

Confusion

Hypothermia

Hypotension

Bradycardia

50
Q

How is myxoedema coma managed?

A

IV thyroid replacement

IV corticosteroids, until the possibility of coexisting adrenal insufficiency has been excluded

IV fluids

Electrolyte imbalance correction

Rewarming

51
Q

What are the features of thyroid eye disease?

A

Proptosis

Lagophthalamos, inability to fully close eyelids

Lid retraction

Opthalmoplegia

52
Q

What is the first line therapy for toxic multinodular goitre?

A

radio-iodine therapy

53
Q

How can thyroid eye disease be prevented?

A

stop smoking

(this is a risk factor for Graves)

54
Q

How much should levothyroxine dose be increased in pregnancy?

A

Up to 50% as early as 4-6 weeks

55
Q

When should levothyroixine be adjusted?

A

Higher dose for pregnancy and lower in ischaemic heart disease

56
Q

Give causes of thyroid storm

A

Stops treatment

Infection

Surgery

Trauma

Acute iodine load

57
Q

How does thyroid storm present?

A

Fever over 38.5ºC

Tachycardia

Confusion and agitation

N&V

Hypertension

HF

Abnormal LFT/jaundice

58
Q

How is thyroid storm managed?

A

Symptomatic treatment, paracetamol

Treatment of underlying precipitating event

B blockers, typically IV propranolol

Anti-thyroid drugs, methimazole

Lugol’s iodine

Dexamethasone, blocks the conversion of T4 to T3

59
Q

What is first line management of thyroid storm?

A

IV B blocker

60
Q

What blood test is used to measure response to treatment in Hashimotos?

A

TSH

61
Q

What is the most common cause of hypothyroidism

A

Iodine deficiency worldwide

Hashimotos in countries were iodine consumption is adequate

62
Q

How does goitre presentation differentiate in hypothyroidism?

A

Hashimotos is associated with non tender goitre

De Quervain’s is associated with a painful goitre

63
Q

Describe the TFT results in non thyroidal illness/sick euthyroid syndrome

A

TSH low (sometimes this is normal) and free T4 low

Common in elderly hospital inpatients

Changes are reversible upon recovery from the systemic illness and hence no treatment is usually needed

64
Q

Describe the TFT results in subclinical hypothyroidism

A

TSH high and free T4 normal

65
Q

Describe the TFT results in patients with poor compliance with levothyroxine

A

TSH high and normal free T4

66
Q

How can steroid therapy affect TFT results?

A

TSH low and normal free T4

67
Q

What group of patients is anaplastic thyroid carcinoma most common in?

A

Elderly females

68
Q

What drug interactions can occur with levothyroxine?

A

Iron and calcium carbonate

Absorption of levothyroxine reduced, give at least 4 hours apart

69
Q

Give side effects of thyroxine therapy

A

Hyperthyroidism

Osteoporosis

Worsening angina

AF

70
Q

Give complications of thyroidectomy

A

Recurrent laryngeal nerve damage

Bleeding and therefore haematomas due to comfined space, rapidly leading to respiratory compromise due to laryngeal oedema

Parthyroid damage and hypocalcaemia

71
Q

How is hyperthyroidism managed in pregnancy?

A

Propylthiouracil

Endocrine (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions