Week 4: Thyroid disease Flashcards
What might a diffuse goitre indicate
- Simple hypertrophy of thyroid without hyper/hypothyroidism or inflammation
- Thyroiditis
- Iodine deficiency
What are causes of iodine deficiency
- Pregnancy (physiological cause, reversed afterwards)
- Grave’s
- Hashimoto’s
Causes of thyroiditis (inflammation of thyroid gland)
- Hashimoto’s
- De Quervain’s (subacute)
- Postpartum
- Drug-induced
What might a nodular goitre indicate
- Toxic/ non-toxic multinodular goitre (toxic = makes too much hormone, non-toxic = makes normal amounts of hormone)
- Cysts
- Fibrosis
What types of thyroid cancers are there
- Benign adenoma
- Papillary
- Follicular
- Medullary
- Anaplastic
- Lymphoma
- Metastases from elsewhere
What diseases (not directly related to the thyroid gland) might cause a goitre
- TB
2. Sarcoidosis
What causes lid lag in hyperthyroidism
Sympathetic overactivity
Note: lid lag occurs with any form of hyperthyroidism
What eye-related signs are specific to Graves disease
- Gritty feeling in eyes
- Eye discomfort
- Chemosis (conjunctiva swelling)
- Periorbital oedema
- Proptosis (sclera visible between iris and lower eye lid)
- Extraocular muscle movement
- Corneal involvement
What investigation should be performed in a person with a thyroid nodule + normal TSH
USS guided FNA
What investigation should be performed in a person with a thyroid nodule + low TSH
Thyroid uptake scan
What should be done with a nodule found to be COLD/INDETERMINATE on a Thyroid Uptake Scan
USS guided FNA
What should be done with a nodule found to be HOT on a Thyroid Uptake Scan
Ablate/ resect/ give drugs
Symptoms of thyroid storm
- Fever, tachycardia, agitaion
- Htn
- V n D
Treatment for thyroid storm
- Beta bockers
- Anti-thyroid drugs (prophylthiauracil)
- Lugol’s iodine (works via the Wolff-Chaikoff effect)
What is the Wolff-Chaikoff effect
- An acute increase in intracellular iodine inhibits thyroid hormone synthesis and release
- Decrease in intracellular iodine
