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MEH > 13 Thyroid Disorders > Flashcards

13 Thyroid Disorders Flashcards

1
Q

What is primary hypothyroidism?
thyroid function test results

A

Low levels of blood T4 due to destruction of thyroid gland.

T3/T4 low
TSH high

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2
Q

What happens to thyroid when you swallow?

A

Moves when you swallow

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3
Q

What is primary hyperthyroidism?

A

High levels of thyroid hormones due to an overactive thyroid gland

fT4 high
TSH low

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4
Q

What does TRH stand for?

A

Thryoptropin-releasing hormone

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5
Q

What does TSH stand for?

A

Thyroid stimulating horomone

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6
Q

What is T4?

A

Thyroxine

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7
Q

What is myxeoedema?

A

Severe underactive thyroid
Extreme hypothyroidism in adults

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8
Q

Symptoms of hypothyroidism

A

lethargy
Weight gain/change in appearance
Puffy eyes
Cold intolerance
Dry hair/skin
Joint/muscle ache
Psychosis

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9
Q

What is the imaging process to look at the thyroid gland?

A

Thyroid scintigraphy
Using technetium-99m isotope

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10
Q

Signs of hypothyroidism

A
  • Bradycardia
  • Slow-relaxing reflexes
  • Peaches and cream-smooth pale skin, pink cheeks
  • loss of eyebrows
  • Pre-orbital oedema- swelling around eyes
  • Carpal tunnel syndrome- causes pain and numbness in fingers, hands and arms
  • cold hands
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11
Q

What does the sign of peaches and cream mean?

A

Smooth pale skin with pink cheeks

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12
Q

What is peri-orbital oedema?

A

Swelling around eyes

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13
Q

Causes of hypothyroidism

A
  • iodine deficiency
  • autoimmunity e.g. hashimoto’s disease
  • post surgery
  • TSH/TRH deficiency
  • medication - anti thyroid drugs
  • dyshormonogensis - hereditary defects in thyroid hormone synthesis
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14
Q

Treatment of hypothyroidism

A

Thyroxine replacement therapy T4 for life
Caution needed in elderly and heart disease

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15
Q

Aims of treatment of hypothyroidism
what do the TSH levels indicate?

A

Resolution of symptoms
Normalisation of blood tests after 6-8 weeks
High TSH indicates under-replacement
Low TSH indicates over-replacement

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16
Q

Symptoms of hyperthyroidism

A
  • weight loss
  • irritability
  • restlessness
  • heat intolerence
  • sweating
  • muscle ache
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17
Q

Signs of hyperthyroidism

A
  • tremor
  • hyperkinesis - state of excessive restlessness
  • tachycardia
  • atrial fibrillation
  • warm hands
  • hypertension
  • proximal myopathy- symmetrical weakness of limbs
  • lid lag - upper eyelid is higher than normal when looking down
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18
Q

Proximal myopathy meaning

A

Symmetrical weakness in limbs

19
Q

Hyperkinesis meaning

A

State of excessive restlessness

20
Q

Iid lag meaning

A

Upper eyelid is higher than normal when looking down

21
Q

Causes of hyperthyroidism

A
  • Graves’ disease - autoimmune
  • thryroiditis
  • excessive T4/3 therapy
  • drugs e.g. amiodarone
  • thyroid carcinoma
  • toxic multinodular goitre
  • ectopic thyroid tissue
22
Q

What is Graves’ disease?

A
  • Autoimmune condition
  • Immune system mistakenly attacks thyroid which cause it to be overactive > hyperthyroidism
  • caused by production of thyroid stimulating immunoglobulin
23
Q

What is nodular thyroid disease?

A

Solid or fluid filled lumps within thyroid

24
Q

Treatment of hyperthyroidism

A
  • Medication - carbimazole + propylthiourcail
  • Surgery
  • Radioactive iodine
25
Q

What are the medications used to treat hyperthyroidism?

A

Carbimazole
Propylthiouracil

26
Q

What is thyroid crisis/storm?

A

Large amount of thyroxine released in short amount of time
Rare complication of hyperthyroidism
Medical emergency - life threatening

27
Q

Symptoms of thyroid crisis/storm

A

Hyperpyrexia >41.5°C
Tachycardia
Cardiac failure
Liver dysfunction

28
Q

What can happen in pregnancy with hyperthyroidism?

A

In Graves’ disease antibodies can cross placenta
Baby can be born with hyperthyroidism

29
Q

side effects of carbimazole

A

Suppressed immune system
Risk of infection

30
Q

What is goitre?

A

Enlargement of thyroid gland

31
Q

Types of goitre

A
  • Diffuse goitre- simple goitre, autoimmune thyroid disease, thyroiditis
  • Nodular goitre- multinodular goitre, solitary nodule RED FLAH SYMPTOM
  • Fibrotic goitre- Riedel’s thyroiditis RARE
  • Iodine deficiency- common worldwide, rare in UK
32
Q

Red flag symptoms of thyroid cancer

A

Very young or old
Rapid enlargement of lump in neck
Hoarse voice + dysphagia -swallowing issues
Family history

Hard irregular thyroid mass
Fixed to surrounding structures
Cervical lymph nodes

33
Q

Where does a thyroglossal cyst present?

A

Exact midline
Moves up when you stick tongue out

34
Q

Investigation of suspected thyroid cancer

A

Thyroid ultra-sound
Fine needle aspiration
CT scan thorax and mediastinum - space within chest

35
Q

what is severe hypothyroidism in infants + how does it present?

A

Cretinism
- dwarfed stature
- mental deficiency
- poor bone development
- slow pulse
- muscle weakness

36
Q

what is severe hypothyroidism in adults + how does it present?

A

myxedema
- thick puffy skin
- muscle weakness
- slow speech
- mental deterioration
- cold intolerance

37
Q

what is hasimoto’s disease?

A

autoimmune disease
destruction of thyroid follicles > hypothyroidism

38
Q

treatment of hashimoto’s disease

A

oral T4
(T4 over T3 as longer half life)

39
Q

presentation of graves disease

A
  • increased BMR
  • excessive sweating
  • weight gain
  • muscle weakness
  • palpitations
  • exophthalmos (bulging eyes)
40
Q

treatment of grave’s disease

A

antithyroid drugs

41
Q

mechanism of antithyroid drugs
example

A

carbimazole
- blocks formation of thyroid hormone
- prevents thyroid peroxidase from coupling + iodinating tyrosines

42
Q

Thyroid function test in hashimoto’s disease

A

Low T3+4
High TSH

43
Q

What does hypothyroidism cause in infants + adults?

A

Infants - cretinism
Adults - myxoedema

44
Q

Thyroid function test in grave’s disease

A
  • increased T3+4
  • low TSH

MEH (23 decks)

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