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MD2 Endocrine > Thyroid Disease > Flashcards

Thyroid Disease Flashcards

1
Q

What is the lifetime risk of thyroid disease in women?

A

20%

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2
Q

When is it especially important to consider thyroid disease?

A

Pregnancy/peripartum

Cardiac disease

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3
Q

List 11 symptoms of hypothyroidism

A

Bradycardia

Cold intolerance and hypothermia

Constipation

Delayed tendon reflexes

Depression

Effusions (pleural, pericardial)

Malaise

Myalgia and generalised myopathy (can be assoc. with increased CK)

Myxoedema

Voice change (e.g. hoarseness)

Weight gain

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4
Q

List 6 causes of primary hypothyroidism

A

ACIDIC:

AI

Congenital

Iodine deficiency

Drugs

Infiltrative disorders

Cures (iatrogenic: Px thyroidectomy, neck irradiation for lymphoma or other cancer)

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5
Q

List 4 causes of transient hypothyroidism

A

Silent thyroiditis (including postpartum)

Subacute thyroiditis

Withdrawal of thyroxine treatment in individuals with an intact thyroid

After radioactive iodine treatment or thyroidectomy

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6
Q

List 2 types of AI hypothyroidism. How are these distinguished clinically?

A

Hashimoto’s thyroiditis: goitre

Atrophic thyroiditis: atrophic, no goitre

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7
Q

List 6 drugs which may cause hypothyroidism

A

Drugs producing iodine excess (e.g. iodine-containing contrast media, amiodarone)

Lithium

Anti-thyroid drugs

p-aminosalicyclic acid

Interferon and other cytokines

Aminoglutethmide

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8
Q

List 4 congenital causes of hypothyroidism

A

Absent or ectopic thyroid gland

Dyshormonogenesis

TSH-R mutation

Iodine deficiency

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9
Q

List 6 infiltrative disorders which may cause hypothyroidism

A

Sarcoidosis

Amyloidosis

Haemochromatosis

Cystinosis

Riedel’s thyroiditis

Scleroderma

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10
Q
A
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11
Q

List 3 causes of secondary hypothyroidism

A

Hypopituitarism (tumours, trauma, surgery or irradiation, infiltrative disorders, Sheehan’s syndrome, genetic pituitary hormone deficiencies)

Isolated TSH deficiency or inactivity

Hypothalamic disease (tumours, trauma, infiltrative disorders, idiopathic)

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12
Q

How is hypothyroidism diagnosed?

A

Elevated TSH

Low FT4

Anti-thyroid Abs (e.g. anti-TPO) may be helpful

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13
Q

When should a thyroid U/S be considered?

A

If there is a palpable goitre (to check for nodules)

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14
Q

What is the relationship between hypothyroidism and IHD, OSA and HF?

A

Can cause hyperlipidaemia

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15
Q

How is hypothyroidism treated?

A

Usually 75-150 mcg/day thyroxine, single dose (some patients e.g. elderly or with IHD, start with 25-50 mcg/day)

Adjust dose after 6-8 weeks (has a half-life of ~1 week, takes 5-6 half lives to reach steady state), unless pt is pregnant (test every few hrs - better to overtreat)

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16
Q

How is treatment for hypothyroidism monitored? What is the aim of treatment?

A

TSH; aim for low normal in young people of child-bearing age (may be naturally higher in the elderly)

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17
Q

What medications may reduce thyroxine absorption and need to be taken separately?

A

Iron tablets

Calcium tablets

Antacids

Cholestyramine (bile acid sequestrant)

18
Q

Is a nuclear scan necessary in hypothyroidism?

A

No

19
Q

List 10 symptoms of hyperthyroidism

A

Loss of weight

Increased appetite

Increased sweating

Heat intolerance

Anxiety, sleep disturbance

Tremor

Hair loss

Palpitations

Diarrhoea

Oligomenorrhoea or amenorrhoea, menstrual irregularity

20
Q

List 5 causes of hyperthyroidism

A

Graves’ disease

Toxic nodular goitre

Iodine-induced

Factitious (surreptitious thyroxine use)

Transient (assoc. with thyroiditis)

21
Q

How does thyroiditis cause a transient hyperthyroidism?

A

Hormone is released from destroyed cells (produces hyperthyroidism initially; following death of cells less hormone is produced)

22
Q

List 2 types of toxic nodular goitre

A

MNG

Adenoma (single toxic nodule)

23
Q

List 3 causes of iodine-induced hyperthyroidism

A

Radiographic contrast

Dietary (e.g. kelp)

Amiodarone

NB Lithium can also cause hyperthyroidism as it acts similarly to iodine

24
Q

Who is at risk of iodine-induced hyperthyroidism?

A

Those with pre-existing thyroid autonomy (e.g. Graves’, goitre due to iodine deficiency, etc)

25
Q

What pathological process is particularly indicative of Graves’ disease? What 5 symptoms/signs are seen?

A

Eye disease: redness and irritation, exopthalmos, lid lag, diploplia on extreme gaze, afferent pupillary defect due to optic nerve compression

26
Q

List 4 common causes of diffuse goitre and 3 causes of nodular goitre

A

Diffuse: DIETARY (iodine deficiency, goitrogen ingestion), CONGENITAL (congenital hypothyroidism), AUTOIMMUNE/INFLAMMATORY (Graves’ disease, Hashimoto’s thyroiditis, subacute thyroiditis which is painful and post-viral), PHYSIOLOGICAL

Nodular: MNG, adenoma, carcinoma

27
Q

What tests are used to diagnose hyperthyroidism?

A

TSH

FT4, FT3

Abs against TSH receptor

Consider a nuclear scan (not in pregnancy)

28
Q

What findings are expected in each of the following on a nuclear scan: Graves’ disease, toxic nodular goitre, iodine or thyroiditis-induced thyrotoxicosis, factitious hyperthyroidism

A

Graves’ disease: diffuse increased uptake

Toxic nodular goitre: focal or heterogenous increased uptake

Iodine or thyroiditis-induced thyrotoxicosis: no increase in uptake (due to iodine overload or damaged cells respectively)

Factitious: no increase in uptake (exogenous thyroxine)

29
Q

How is a nuclear scan interpreted? What element is used in a nuclear scan?

A

Compare the density of the thyroid gland to the density of the salivary glands

Previously iodine, now technetium used (cheaper)

30
Q

How is hyperthyroidism treated?

A

Pharmacologically: antithyroid drugs (carbimazole, propylthiouracil) B-blockers to alleviate symptoms

Radiologically: radioactive iodine

Surgically: thyroidectomy/lobectomy

31
Q

When is surgery indicated in hyperthyroidism?

A

ADRs, radioactive iodine therapy CI

Large goitre with obstructive or cosmetic concerns

Risk of malignancy (any nodules)

32
Q

2 important adverse effects of carbimazole and propylthiouracil

A

Allergy

Agranulocytosis

Cholestasis and hepatotoxicity (elevation in serum aminotransferases, ALP, GGT)

33
Q

How are antithyroid drugs used in Graves’ disease (dose and duration)?

A

Treat for 12-18 months with 10-40mg carbimazole/day in divided doses; gradually reduce dose every 6 weeks (dependent on clinical state and ongoing TFTs)

34
Q

How are antithyroid drugs used in toxic nodular disease?

A

Long term, low dose treatment (5-10mg carbimazole/day)

35
Q

Adverse effects of radioactive iodine

A

Hypothyroidism (common, ~20%)

Eye disease (rarer; CI if pre-existing)

36
Q

3 contraindications for radioactive iodine therapy

A

Pregnancy

Thyroid eye disease

High amounts of ordinary iodine in previous months (e.g. radiographic contrast, kelp)

37
Q

Name 2 precipitants which may worsen thyroid eye disease

A

Smoking

Radioactive iodine

38
Q

What modes of imaging are not necessary or may be contraindicated in hyperthyroidism?

A

Contrast CT (contrast may exacerbate thyrotoxicosis)

U/S (unnecessary; may be done to better characterise nodules in MNG)

39
Q

What findings are seen in a subclinical hypothyroidism?

A

TSH elevated

FT4, FT3 normal

May be helpful to measure anti-TPO Abs as high titres may increase risk of progression to overt hypothyroidism

40
Q

What are the risks in subclinical hypothyroidism? How should patients with subclinical hypothyroidism be managed?

A

Risk of progression to overt hypothyroidism, may be increased long term CV risk (but inconclusive evidence)

Observe or treat according to clinical circumstances

41
Q

Steps for management of goitre

A

Determine if hyper-, hypo- or euthyroidic

If euthyroidic: see if pressure symptoms, whether pt is concerned (cosmetic reasons, symptoms, etc)

Risk of malignancy greater with solitary or multiple nodules? Solitary (20-30%; dependent on other factors, e.g. older?, male, smokers, childhood exposure to radiation)

Can look at U/S features to determine risk of cancer

macrocalcification - nodule has been there a long time

microcalcification - higher risk of malignancy (as in breast cancer)

presentation of thyroid cancer: usually euthyroidic, may present with neck lump, often incidentally picked up, can present with hoarse voice or lymphadenopathy, common types include papillary (~70%), follicular, rarer including medullary (neuroendocrine/carcinoid, of C cells, produce calcitonin?) and anaplastic (aggressive, diagnosed late, poor prognosis, doesn’t typically form a nodule), can be mixed papillary/follicular; in most cases remove entire thyroid (easier to monitor) and give radioactive iodine (higher doses than used for Graves’ or toxic nodules; usually 80-100 Hg), can monitor by measuring thyroglobulin (should not have any thyroglobulin post-treatment), very sensitive marker

MD2 Endocrine (11 decks)

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