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Stage 3: FOCP > Uro/Endo week: Thyroid > Flashcards

Uro/Endo week: Thyroid Flashcards

1
Q

Hormones released by posterior pituitary gland

A
  • Oxytocin

* ADH

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2
Q

Hormones released by anterior pituitary gland

A
  • TSH
  • ACTH
  • FSH & LH
  • GH
  • Prolactin
  • Endorphins
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3
Q

6 hormones released by hypothalamus

A
  • Thyrotropin RH
  • Gonadotropin RH
  • Growth hormone RH
  • Corticotropin RH
  • Somatostatin
  • Dopamine
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4
Q

Describe the thyroid negative feedback loop

A

Hypothalamus releases TRH

Anterior pituitary gland releases TSH

Thyroid gland releases T3 and T4

Circulating levels of T3 and T4 downregulate hormone release from hypothalamus and anterior pituitary gland

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5
Q

Is T3 or T4 active form

A

T3

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6
Q

Symptoms of hyperthyroidism

A
  • weight loss
  • increased appetite
  • heat intolerance
  • irritability, palpitations
  • sweaty skin
  • diarrhoea
  • exopthalmos
  • irregular menses
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7
Q

Symptoms of hypothyroidism

A
  • weight gain
  • reduced appetite
  • cold intolerance
  • lethargy, depression
  • dry skin, nails
  • constipation
  • hair loss
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8
Q

Questions to ask about in thyroid history

A
  • weight changes
  • appetite changes
  • heat/cold intolerance
  • lethargy vs irritability/palpitations
  • sweaty vs dry skin
  • constipation vs diarrhoea
  • eye changes
  • hair loss
  • menstrual changes
  • swelling
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9
Q

Is non-pitting oedema a sign of hyperthyroidism or hypothyroidism

A

Usually hypothyroidism.

Only exception: Graves (autoimmune hyperthyroidism)

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10
Q

Differentiating hyper and hypothyroidism in examination:

  • goitre
  • fast/slow reflexes
A

Goitre: both have

Fast reflexes: hyperthyroidism
Slow reflexes: hypothyroidism

(note: atrophic thyroiditis has no goitre)

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11
Q

What is thyroid acropachy and is it present in hyper/hypo thyroidism

A
  • Swelling of soft tissue of hands
  • finger clubbing
  • commonly affects metacarpals

Sign of Graves (hyperthyroidism)

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12
Q

Pathophysiology of Hashimoto’s

A
  • autoantibodies attack TSH receptors

- CD8 and CD4 activation lead to thyrocyte destruction

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13
Q

Pathophysiology of Grave’s

A
  • thyroid stimulating immunoglobulins bind to TSH receptor
  • increased T3 and T4 secretion
  • negative feedback loop results in low TSH and high circulating T3 and T4
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14
Q

Specific diagnostic signs for Hashimoto’s

A

-Autoantibodies against TSH receptors

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15
Q

Specific diagnostic signs for Grave’s (including specific signs on examination)

A
  • TSH receptor antibodies
  • exopthalmos
  • non-pitting oedema (pretibial myxodema)
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16
Q

Low TSH
High T4 and T3

–> hyper or hypothyroidism

A

Hyperthyroidism

17
Q

Normal range of levels for

  • TSH
  • fT4
  • fT3
A

TSH: 0.4-4.0
fT4: 10-25
fT3: 3.5-7.5

18
Q

What is the diagnosis

high TSH, low T3, low T4

A

Primary hypothyroidism

19
Q

What is the diagnosis

low TSH, low T3, low T4

A

Secondary hypothyroidism

20
Q

What is the diagnosis

low TSH, high T3, high T4

A

Primary hyperthyroidism

21
Q

What is the diagnosis

high TSH, high T3, high T4

A

Secondary hyperthyroidism

22
Q

Hyperthyroidism diseases

A
  • Graves
  • Toxic multinodular goitre
  • Toxic adenoma
  • De Quervain’s thyroiditis (acute inflammation of gland from virus)
  • Post-partum thyroiditis
23
Q

Hypothyroidism diseases

A
  • Graves disease post treatment
  • Thyroiditis
  • Iatrogenic – surgery, radiotherapy
  • Congenital
  • Iodine excess/deficiency
  • Disease of increasing age
  • Drug-induced
24
Q

Which drugs induce hypothyroidism

A

Amiodarone
Lithium
Carbimazole
IFN

25
Q

Which thyroid disorder might hoarse/ deep voice with associated with

A

Hypothyroidism

26
Q

Which thyroid disorder might kyphosis and osteoporotic fractures be with associated with

A

Hyperthyroidism

27
Q

When asking pt to swallow during thyroid exam, how to differentiate swellings, among:

  • thyroid gland mass
  • thyroglossal cyst
  • lymph nodes
A

thyroid gland mass: moves with swallowing

thyroglossal cysts: moves with swallowing

lymph nodes: barely move with swallowing

28
Q

When asking pt to stick out tongue during thyroid exam, how to differentiate swellings, among:

  • thyroid gland mass
  • thyroglossal cyst
  • lymph nodes
A

thyroid gland mass: DO NOT MOVE

thyroglossal cysts: move upwards noticeably

lymph nodes: DO NOT MOVE

29
Q

Briefly describe thyroid exam:

look
palpate
percuss
auscultate
special tests
A

LOOK
-general: lethargy, dry hair

  • neck: ask to swallow and stick out tongue
    hands: dry/sweaty skin, thyroid acropachy, tremor, feel pulse
  • face: pigmentation
  • eyes: exopthalmos, H movement test, lid lag

PALPATE

  • thyroid
  • lymph nodes
  • trachea

PERCUSS
-downwards from sternal notch (for goitre)

AUSCULTATE
-thyroid for turbulent blood flow

SPECIAL TESTS

  • reflexes
  • proximal myopathy
30
Q

Which thyroid disorder might palmar erythema be with associated with

A

Hyperthyroidism

31
Q

Which thyroid disorder might carpal tunnel syndrome be with associated with

A

Hypothyroidism

32
Q

Problems with which structures would be the cause of secondary hyper/hypothyroidism

A

Hypothalamus

Pituitary gland

Stage 3: FOCP (47 decks)

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