Thyroid pathology Flashcards
What is myxoedema?
Severe hypothyroidism
Medical emergency
What is Grave’s disease?
A rare autoimmune condition that can cause hyperthyroidism
IgG antibodies bind to TSH, stimulating thyroid hormone production
What are 3 autoimmune causes of hypothyroidism?
Atrophic thyroiditis
Hashimoto’s thyroiditis
Postpartum thyroiditis
What is atrophic thyroiditis?
Autothyroid antibodies are present which eventually result in atrophy and fibrosis of gland
What is Hashimoto’s thyroiditis?
autoimmune destruction of thyroid gland which lowers hormone levels
What is postpartum thyroiditis?
After pregnancy the immune system is altered which can result in hypo/hyper -thyroidism
What indicates permanent hypothyroidism in postpartum thyroiditis?
When conventional autoantibodies are found
List a cause of hypothyroidism that is to do with hormone deficiency?
Iodine deficiency
List some symptoms and signs of hypothyroidism…
weight gain cold intolerance bradycardia dry hair/skin tiredness anaemia constipation
What is the 1st line investigation in suspected hypothyroidism and what are the results?
Serum TSH
high TSH, low T4/T3
How do you manage hypothyroidism?
Levothyroxine (T4)
young - 50-100 micrograms
old - 25-50 micrograms
What is the most common cause of hypothyroidism?
Hashimoto’s thyroiditis
What is the typical patient that has myxoedema coma?
elderly woman with untreated hypothyroidism
What is the most common cause of hyperthyroidism?
Grave’s disease
List some symptoms and signs of hyperthyroidism…
Weight loss irritability heat intolerance sweating thirst diarrhoea eye disease (only in Grave's) tachycardia/AF goitre
List one feature of Grave’s disease…
thyroid eye disease
What is thyrotoxicosis?
The state of tissues due to excess thyroid hormone
List causes of thyroiditis…
Grave's solitary nodule toxic multinodular goitre De quervain's thyroiditis psotpartum thyroiditis
What investigation is done in suspected hyperthyroidism and what will it show?
serum TSH
low TSH, high T4 or T3
What are 4 ways to manage hyperthyroidism?
Antithyroid drugs
Beta blockers
radioiodine
thyroidectomy
What is the first line antithyroid drug?
carbimazole
What antithyroid drug is used in the first trimester of pregnancy?
Propylthiouracil
When is radioidine the 1st line treatment for hyperthyroidism?
relapsed Grave’s disease or nodular thyroid disease
What is a thyroid storm and who is it likely to affect?
Severe hyperthyroidism
Emergency
Thyroid pts. with recent thyroid surgery or acute illness
What is sick euthyroid syndrome?
In an unwell patient
suppressed TSH but then rises during recovery
What is goitre?
thyroid enlargement
list 3 causes of diffuse goitre…
Simple goitre (no clear cause) autoimmune thyroid disease thyroiditis
What percentage of thyroid nodules are malignant?
5%
Does a thyroid nodule move on swallowing?
yes
What is the most common malignant thyroid nodule?
papillary thyroid carcinoma
What are the different types of malignant thyroid nodule?
papillary thyroid carcinoma follicular thyroid carcinoma medullary thyroid carcinoma lymphoma anaplastic
What investigations can be done if there are present thyroid nodules?
TSH
Fine needle aspiration guided by ultrasound
