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JL Endocrinology > Week 3 (2) > Flashcards

Week 3 (2) Flashcards

1
Q

What is the commonest cause of hypo/hyper thyroidism?

A

Autoimmune thyroid disease

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2
Q

What has low TSH, high T4 and T3?

A

Hyperthyroidism

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3
Q

What has high TSH, and low T4/T3?

A

Hypothyroidism

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4
Q

What condition has high TSH and high T4/3?

A

TSH oma (rare - pituitary disease secondary hyper/hypothyroidism)

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5
Q

What condition has low TSH and T4/3?

A

Pituitary gland failure

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6
Q

What refers to either severe hypothyroidism e.g. myxoedema coma or to accumulation of hydrophilic mucopolysaccharides in the ground substance of the dermis and other tissues-doughly induration of the skin classical seen in the shins = pretibial myxoedema which is seen in graves disease?

A

Myxoedema

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7
Q

Give two goitrous causes of primary hypothyroidism?

A
  1. Chronic thyroiditis - hashimotos thyroiditis (autoimmune)

2. Iodine deficiency

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8
Q

Name a drug which causes iodine deficiency?

A

Amiodarone, lithium, IL-2

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9
Q

Give four non-goitrous causes of primary hypothyroidism?

A
  1. Congenital developmental defect
  2. Atrophic thyroiditis
  3. Post-ablative (radioiodine)
  4. Postradiation
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10
Q

Give four hypothalmic causes of secondary hypothyroidism?

A
  1. Congenital
  2. Infection: encephalitis
  3. Infiltration: sarcoidosis
  4. Malignancy: craniopharyngioma
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11
Q

What is characterised by: presence of thyroid peroxidase antibodies in blood and T-cell infiltrate and inflammation on microscopy?

A

Autoimmune hypothyroidism aka Hashimoto’s thyroiditis

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12
Q

What intolerance do hypothyroidism patients have?

A

Cold intolerance

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13
Q

What type of fluid retention do hypothyroidism people get?

A

Pitting oedema

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14
Q

Give a cutaneous association wit hhypothyroidism?

A

Vitiligo

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15
Q

Name four cardiac symptoms of hypothyroidism?

A
  1. Reduced heart rate
  2. Cardiac dilatation
  3. Pericardial effusion
  4. Worsening of heart failure
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16
Q

Name one metabolic sign of hypothyroidism?

A

Hyperlipidaemia
Decreased appetite
Weight gain

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17
Q

Name three GI signs of hypothyroidism?

A
  1. Constipation
  2. Megacolon
  3. Ascites
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18
Q

Give three respiratory signs of hypothyroidism?

A
  1. Deep hoarse voice
  2. Macroglossia
  3. Obstructive sleep apnoea
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19
Q

What are these symptoms seen in: decreased intellectual and motor activities, dpression and psychosis, muscle stiffness, peripheral neuropathy and prolongation of tendon jerks?

A

Hypothyroidism

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20
Q

What condition of the wrist is seen in hypothyroidism?

A

Carpal tunnel syndrome

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21
Q

Give three gynaecology issues with hypothyroidism?

A
  1. Menorrhagia
  2. Later oligo-or amenorrhoea
  3. Hyperprolactinaemia - increase TRH causes, increase prolactin secretion
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22
Q

What is macrocytosis typical in and what should be ruled out?

A

Hypothyroidism and rule out a concurrent vitamin B12 deficiency

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23
Q

In hypothyroidism - is LDL cholesterol and CK increased or decreased?

A

Increased

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24
Q

What condition has 70-80% anti-TPO antibody, 30-50% anti-thyroglobulin antibody and 70-100% TSH receptor antibody?

A

Graves disease

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25
Q

What thyroid condition has 95% anti-TPO antibody, 60% anti-thyroglobulin antibody and 10-20% TSH receptor antibody?

A

Autoimmune hypothyroidism

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26
Q

What should be given to younger patients with hypothyroidism?

A

Thyroxine 50-100 ug daily

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27
Q

What should be given to elderly patients with IHD and hypothyroidism?

A

Thyroxine at 25-50ug daily, adjusted every 4 weeks to response

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28
Q

What should be checked in hypothyroidism patients adter 2 months of any dose change?

A

TSH

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29
Q

When might thyroxine (T4) doses by increased in a patient?

A

By 25-50% in pregnancy - increased TBG

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30
Q

What is the difference between primary and secondary hypothyroidism?

A
  1. TSH reflects tissue thyroid hormone actions in primary and it is not a useful in secondary as it will remain low if T4 therapy is commenced.
  2. TSH is an index of therapeutic success and potential toxicity in primary and T4 is used to monitor treatment in secondary.
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31
Q

What affects elderly women with long standing but frequently unrecognized or untreated hypothyroidism

A

Myxoedema coma

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32
Q

In relation to hypothyroidism - what does ECG: bradycardia, low voltage complexes, varying degrees of heart block, Twave inversion and prolongation of QT interval suggest?

A

Myxoedema coma

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33
Q

Name two cardiac symptoms and two sympathetic symptoms of hyperthyroidism?

A

1, Palpitations/AF

  1. Cardiac failure
  2. Tremor
  3. Sweating
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34
Q

Give three vision symptoms of hyperthyroidism?

A
  1. Lid retraction
  2. Double vision
  3. Eyes that bulge out or protrude in patients with Graves
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35
Q

What happens to menstrual cycle in hyperthyroidism?

A
  1. Lighter bleeding and less frequent periods
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36
Q

Name an autoimmune cause of Hyperthyroidism?

A

Graves disease

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37
Q

Name two nodular thyroid causes of hyperthyroidism?

A
  1. Multinodular goitre

2. Toxic nodule

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38
Q

Name two thyroiditis (inflammation) causes of hyperthyroidism?

A

Subacute and post-partum

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39
Q

Name two medications and one supplement which cause hyperthyroidism (iodine causes)?

A

Amiodarone, thyroxine and kelp

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40
Q

What antibody is positive in Graves?

A

TRAbs - TSH receptor antibody

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41
Q

What test other than TSH and antibody positive is used for Graves?

A
  1. Smooth symmetrical goitre - scintigraphy - high uptake/ultrasound
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42
Q

What is Graves natural progression?

A

At 18 months 50% will have burnt out and 50% will relapse

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43
Q

What do lid retraction, lid lag, chemosis, proptosis, visual loss and diplopia signs of?

A

Graves

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44
Q

What cause of hyperthyroidism are older patients more likely to get

A

Nodular thyroid disease

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45
Q

Name two tests other than TSH that are used for Nodular thyroid disease?

A
  1. Antibody negative TRAbs

2. Assymetrical goitre

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46
Q

How is a thyroid storm treatd?

A
  1. Lugols iodine
  2. Glucocorticoids
  3. PTU
  4. B-blockers
  5. fluids and monitoring
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47
Q

Name two medications used to treat hyperthyroidsim?

A
  1. Carbimazole

2. Propylthiouracil (preferred in pregnancy)

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48
Q

What is there a risk of with medication for hyperthyroidism?

A

Agranullocytosis

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49
Q

What can be used to treat symptoms in hyperthyroidism?

A

Beta-blockers

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50
Q

What type of thyroiditis is viral triggered and may be associated with throat/fever/other viral symptoms?

A

De Quervains

51
Q

What tests are there for De Quervains/ sub-acute thyroiditis?

A
  1. T4- high in early stage, low in late
  2. TSH - low in early stage, high in late
  3. Scintigraphy Scan - low uptake
52
Q

What areas does amiodarone induced thyrotoxicosi occur more frequently in?

A

Low iodine intake

53
Q

What areas does amiodarone induced hypothyroidism occur more frequenly in?

A

High iodine intake

54
Q

What embryological thyroid abnormalities result from failure of descent? excessive descent? thyroglossal duct cyst?

A

Linguial thyroid
Retrosternal location in mediastinum
thyroglossal duct cyst

55
Q

What is the thyroid composed of?

A

Follicles

56
Q

What are each follcie surrounded by in the thyroid?

A

Flat to cuboidal follicular epithelial cells

57
Q

What is in the centre of each follicle?

A

Thyroglobulin

58
Q

What cells present in the thyroid are large with a clear cytoplasm, secrete calcitonion and reult in lower serum Ca levels?

A

Parafollicular C cells

59
Q

What do polymorphisms in CTLA-4 nad PTPN-22 cause?

A

Autoimmune thyroditis

60
Q

What are the triad of features in graves disease?

A
  1. Hyperthyroidism with diffuse enlargement of the thyroid
  2. Eye changes
  3. Pretibial myxoedema
61
Q

What two anti-thyroid antibodies are found in hashimotos thyroiditis#?

A
  1. Anti-thyroglobulin

2. Anti-peroxidase

62
Q

In Hashimotos thyroiditis = what cells may mediate destruction of thyroid epithelium?

A

CD8+

63
Q

What do orphan ani nuclei make the diagnosis of?

A

Papillary carcinoma

64
Q

What does a medullary carcinoma come from?

A

C cell hyperplasia

65
Q

What is parathyroid composed of?

A

Chief cells - secrete PTH, act on Ca homeostasis

66
Q

What is the parathyroid supported by?

A

Oxyphil cells - slightly larger cells with acidophilic cytoplasm

67
Q

What does chronic hypocalcaemia cause?

A

Compensatory over activity of parathhyroid glands

68
Q

What type of hperparathyroidism is associated with hypercalcaemia?

A

Tertiary

69
Q

What do bone disease, nephrolithiasis (stones), constipation, depression and weakn ess and fatigue suggeest?

A

Hyperparathyroidism

70
Q

What might suggest hypoparathyroidism on ECG?

A

Prolonged QT interval

71
Q

What are the three key events in ovarian cycle?

A
  1. Follicular growth
  2. Ovulation
  3. Luteal function
72
Q

What hormone is produced when follicle is present in pregnancy?

A

Oestradiol

73
Q

What hormone is produced when follicle is implanted in pregnancy?

A

HCG - pregnancy test

74
Q

What hormone is released when corpus luteum is left in pregnancy?

A

Progesterone

75
Q

What hormone is released when placenta is in place during pregnancy?

A

Human Placental Lactogen

76
Q

What hormone does pituitary release in pregnancy?

A

Prolactin

77
Q

What two hormines increase insulin resistance in the mother?

A
  1. Progesterones

2. Human Placenta Lactogen

78
Q

When does gestational diabetes usually come?

A

In last third of pregnancy

79
Q

When does foetal organogensis start?

A

At 5 weeks

80
Q

Name three complications of gestational diabetes?

A
  1. Macrosomia
  2. Polyhydramnios
  3. Intrauterine death
81
Q

Name three complications of type I and II diabetes in pregnancy?

A
  1. Congenital malformation
  2. Prematurity
  3. Intra-uterine growth retardation
82
Q

What does foetal hyperinsulinemia lead to?

A

Macrosomia

83
Q

What two drugs should be avoided in type I and Ii diabetic prenancy management>

A
  1. Statins

2. ACE inhibitors

84
Q

Name a drug used to treat MODY?

A

Glibenclamide

85
Q

What should be done 6 weeks post natal in gestational diabetic patients?

A

Glucose tolerance testing

86
Q

If you get gestational diabetes what are the chances of becoming type II diabetic after 10-15 years?

A

50%

87
Q

Name a good drug to control blood pressure in gestational diabetes?

A

Methyldopa

88
Q

What causes anovulatory cycles?

A

Hypo/hyperthyroidism

89
Q

What can HCG lower and increase in pregnancy?

A

Low TSH and increase fT4

90
Q

What does a high HCG in pregnancy cause?

A

Morning sickness and extreme vomiting

91
Q

Does the thyroid get bigger in pregnancy?

A

Yed

92
Q

In a hypothyroidism pregnant patient - what levels should TSH be aimed for in first trimestter and second/third?

A

First -

93
Q

What do TSH and HCG do to thyroxine?

A

Increase it

94
Q

What condition in pregnancy causes infertility, spontaneous miscarriage, stillbirth, thyroid criss in labour and transietn neonatal thyrotoxicosis?

A

Hyperthyroidism

95
Q

If using drugs to treat hyperthyroidism in pregnancy - what two should be used and when?

A

Propylthiouracil in first rimester

Carbimazole in second and third

96
Q

Give some complications of carnbimazole?

A
  1. Scalp abnormalities

2. Choanal anf oesophageal atresia

97
Q

Give two complications of propylthiouracil?

A

1.rISK OF LIVER TOXICITY

98
Q

What is caused when TRAb antibodies cross the placenta?

A

Neonatal transient hyperthyroidism

99
Q

Name two hormones released from hypothalamus and stored in posterior pituitary?

A
  1. vASOPRESSIN

2. Oxytocin

100
Q

What does CRH cause release of in the pituitary?

A

ACTH

101
Q

What does TRH cause release of in the pituitary?

A

TSH

102
Q

What does GnRH cause release of in pituitary?

A

LH/FSH

103
Q

What does GHRH cause release of in the pituitary?

A

GH

104
Q

What does DA cause release of in pituirtary?

A

PRL

105
Q

What hormones pair with LH/FSH in the peripheral?

A

Testosterone or estradiol

106
Q

What hormone pairs with GH in peripheral?

A

IGF-1

107
Q

Name a dynamic pituitary test?

A

Insulin Stress Test

108
Q

In a water deprivation test if ur/serum osmol ration is >2 what does it mean?

A

Normal

109
Q

What dynamic pituitary function test would you do (stimulation_ of IHD patients?

A

Prolonged glucagon test

110
Q

What is the cause of compression on optic chiasm, compression on cranil nerves, hypoadrenalism, hypothyroidism, hypogonadism, DI and GH deficiency?

A

Non functioning pituitary adenoma

111
Q

What does dopamine inhibit?

A

PROLACTIN

112
Q

Name a dopamine antagonist which raises prolactin?

A

Metoclopramide

113
Q

Do antidepressants raise prolactin?

A

YES

114
Q

Name three pathological causes of raised prolactin?

A
  1. Hypothyroidism
  2. Stalk lesions
  3. Prolactinoma
115
Q

Do females or males present first with prolactinoma?

A

Females first

116
Q

What does galactorrhoea, menstrual irregularity, ammenorrhoea and infertility suggest?

A

Prolactinoma

117
Q

What drugs are used to treat prolactinoma?

A

Dopamine agonists- bromocriptine, quinagolide and cabergoline

118
Q

Name two local pituitary effects acromegaly patients get?

A

Visual fields and hypopituitarism

119
Q

What are two tests for acromegaly?

A

IGF-1 and GTT

120
Q

What are cabergoline, octreotide and pegvisomant used to treat?

A

Acromegaly

121
Q

What drugs used in acromegaly reduce GH in mosy patients?

A

Somatostatin analogues

122
Q

Name a few side effects of somatostatin analogues?

A
  1. Local stinging
  2. Flatulemce, diarrhoea, abdo pain
  3. Gastritis
  4. Gallstones
123
Q

Name a GH antagonist used in acromegaly?

A

Pegvisomant - last line as so expensive

JL Endocrinology (12 decks)

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