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Endocrine clinical conditions > Thyroid disorders > Flashcards

Thyroid disorders Flashcards

1
Q

what are the symptoms of hypothyroidism?

A 
weight gain
cold intolerance 
slow reflexes 
slow speech 
constipation
heavy periods
dry skin/hair
bradycardia
goitre 
if severe- puffy eyes, swollen tongue, hoarseness, coma
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2
Q

what are the symptoms of hyperthyroidism?

A 
weight loss
heat intolerance 
anxiety/irritability 
bowel infrequency 
sweaty palms
light periods
hyperreflexia / tremor
goitre 
thyroid eye disease
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3
Q

if there is raised TSH and low T3, T4 what is this?

A

primary hypothyroidism

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4
Q

if there is low TSH and normal T4,T3 what is this?

A

subclinical (compensated) hypothyroidism

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5
Q

if there is low TSH and low T3, T4, what is this?

A

secondary hypothyroidism

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6
Q

what are causes of acquired hypothyroidism?

A

hashimotos autoimmune
iatrogenic;
- post radioactive iodine (treatment for hyperthyroidism)
- radioactive iodine for H & N cancers
chronic iodine deficiency
post partum thyroiditis

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7
Q

what are the causes of secondary hypothyroidism?

A 
pituitary tumour
craniopharyngioma 
post pituitary surgery or radiotherapy
sheehans syndrome
isolated TSH deficiency
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8
Q

if you suspected hyperthyroidism, what investigations would you carry out?

A

TSH
Thyroxine
autoantibodies

FBC
lipids
hyponatraemia 
increased muscle enzymes
hyperprolactinaemia
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9
Q

what is the treatment for hypothyroidism?

A

levothyroxine tablets

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10
Q

when would you treat subclinical hypothyroidism?

A

if TSH >10
of if TSH >5 with positive thyroid antibodies
or TSH elevated with symptoms

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11
Q

what are the risks with over treatment of thyroxine?

A

osteopenia

AF

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12
Q

what are physiological causes of goitre?

A

puberty

pregnancy

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13
Q

what are the different types of goitre?

A 
diffuse goitre
multi nodular 
solitary nodule 
cyst
adenoma, carcinoma, lymphoma 
miscellaneous i.e. sarcoidosis
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14
Q

how would you investigate a solitary nodular goitre?

A

TFT’s
USS
FNA
isotope scanning of low TSH

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15
Q

what are differentiated thyroid cancers?

A

papillary
follicular
lymphoma

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16
Q

what are the non differentiated thyroid cancers?

A

medullary

anaplastic

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17
Q

what thyroid cancer spreads via lymphatics?

A

papillary

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18
Q

where does follicular thyroid cancer spread to?

A

bone

lung

19
Q

what is the treatment for differentiated thyroid cancers?

A

radioiodine

near total thyroidectomy

20
Q

what is the thyroid cancer marker?

A

thyroglobulin

21
Q

what is the treatment for medullary thyroid cancer?

A

prophylactic thyroidectomy

22
Q

what is the treatment for anapaestic thyroid cancer?

A

external radiotherapy

23
Q

what thyroid cancer arises from parafollicular C cells?

A

medullary

24
Q

what thyroid cancer is associated with MEN 2 and what is this associated with?

A

medullary

phaechromocytoma & hyperparathyroidism

25
Q

in what thyroid cancer is the serum Ca level raised and why?

A

medullary

because it is associated with MEN 2 which can cause hyperparathyroidism

26
Q

does thyrotoxicosis result in hyper or hypothyroidism?

A

hyper

27
Q

what are the primary causes of hyperthyroidism?

A

autoimmune hashimotos
toxic multi nodular goitre
toxic adenoma

28
Q

what are the causes of thyrotoxicosis without hyperthyroidism?

A

excessive thyroxine administration

destructive thyroiditis - post partum, amiadorone induced, subacute

29
Q

what is the presentation of sub acute (de Quervain’s) thyroiditis?

A

presents with hyperthyroidism for 3-6 weeks then hypothyroidism occurs for the following 3-6 months
often recall having painful goitre +- fever, malaise, myalgia

30
Q

what is the treatment for hyperthyroidism?

A

anti thyroid drugs;
- carbimazole & propylthiouracil
(titration regimen)

steroids
radioiodine
betablockers

31
Q

what are the side effects of anti thyroid drugs?

A

rash

agranulocytosis

32
Q

what is the difference in the initial treatment of someone with hypothyroidism and also ischaemic heart disease?

A

start initial dose at 25mcg/day and slowly titrate up every 2-4 weeks until it reaches 75-100mc/day
(normally would start at 50mcg/day)

33
Q

when would you treat subclinical hypothyroidism?

A

if TSH > 10 even with no symptoms
if TSH > 5 if positive thyroid antibodies
always treat if they have definitive symptoms
always treat if they become pregnant

34
Q

what is the change in treatment of hypothyroidism in pregnancy?

A

double levothyroxine dose

35
Q

is thyroxine treatment for post part thyroiditis life-long?

A

no

trial withdrawal within 6-12 months

36
Q

what is myxedema coma and how do you treat it?

A

severe hypothyroidism resulting in a coma

treat with IV T3 and IV steroid

37
Q

What drugs can cause hypothyroidism?

A

Amiadorone
Lithium
Interferon

38
Q

What precipitates sub acute thyroiditis (De Quervains syndrome)

A

Viral infection

39
Q

What is the cause(s) of secondary hyperthyroidism?

A

TSH secreting pituitary adenoma

40
Q

What can cause thyrotoxicosis without hyperthyroidism?

A

post partum thyrotoxicosis
sub acute syndrome
Drug induced I.e. amiadorone
Excessive thyroxine administration

41
Q

what is the action of goitrogens?

A

goitrogens disrupt the thyroid’s ability to produce thyroid hormones by interfering with iodine uptake in the thyroid gland
this results in the pituitary producing more TSH due to reduced negative feedback

42
Q

what causes thyrotoxicosis without hyperthyroidism?

A

post partum thyroiditis
sub acute (De Quervains syndrome)
amiadorone induced
excessive thyroxine administration

43
Q

what does sheehan’s syndrome cause?

A

secondary hypothyroidism

post partum haemorrhage or hypotension damages the pituitary

44
Q

what triggers sub acute (de Quavairns) syndrome and how do you treat it?

A

triggered by virus i.e. enteroviruses - coxsackie

May require short term steroids NSAIDS

Endocrine clinical conditions (12 decks)

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