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Endocrinology > Hypo/Hyperthyroidism and Thyroiditis > Flashcards

Hypo/Hyperthyroidism and Thyroiditis Flashcards

1
Q

define primary thyroid disease

A

disease affecting the thyroid gland itself

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2
Q

define secondary thyroid disease

A

hypothalamic or pituitary disease - no thyroid pathology

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3
Q

where is TSH secreted and in response to what?

A

TSH secreted from anterior pituitary in response to TRH from hypothalamus

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4
Q

what is 99% of T3 and T4 bound to?

A

TBG, albumin and pre-albumin

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5
Q

primary hypothyroidism - low or high:

(a) free T3/4
(b) TSH

A

primary hypothyroidism - low or high:

(a) free T3/4 - LOW
(b) TSH - HIGH

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6
Q

primary hyperthyroidism - low or high:

(a) free T3/4
(b) TSH

A

primary hyperthyroidism - low or high:

(a) free T3/4 - HIGH
(b) TSH - LOW

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7
Q

secondary hypothyroidism - low or high:

(a) free T3/4
(b) TSH

A

secondary hypothyroidism - low or high:

(a) free T3/4 - LOW
(b) TSH - LOW/NORMAL

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8
Q

secondary hyperthyroidism - low or high:

(a) free T3/4
(b) TSH

A

secondary hyperthyroidism - low or high:

(a) free T3/4 - HIGH
(b) TSH - HIGH/NORMAL

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9
Q

any disorder that results in insufficient secretion of thyroid hormones from the thyroid gland defines what?

A

hypothyroidism

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10
Q

define myxoedema

A

severe hypothyroidism and is a medical emergency

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11
Q

define oretibiyal myxoedema

A

a rare clinical sign of Graves’ disease, an autoimmune thyroid disease which results in hyperthyroidism!

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12
Q

name the 3 types of primary hypothyroidism

A

goitrous
non-goitrous
self-limiting

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13
Q

goitrous, non-goitrous or self-limiting:

Chronic thyroiditis (Hashimoto’s thyroiditis)

Iodine deficiency
Drug-induced (e.g. amiodarone, lithium)

Maternally transmitted (e.g. antithyroid drugs)

Hereditary biosynthetic defects

A

goitrous

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14
Q

goitrous, non-goitrous or self-limiting:

Atrophic thyroiditis

Post-ablative therapy (e.g. radioiodine, surgery)

Post-radiotherapy (e.g. for lymphoma treatment)

Congenital developmental defect

A

non-goitrous

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15
Q

goitrous, non-goitrous or self-limiting:

Following withdrawal of antithyroid drugs

Subacute thyroiditis with transient hypothyroidism

Post-partum thyroiditis

A

self-limiting

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16
Q

name the most common cause of autoimmune hypothyroidism

A

hashimoto’s thyrioditis

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17
Q

what is hashimoto’s thyroiditis characterised by the presence of?

A

antibodies against thyroid peroxidase (TPO)

T-cell infiltrate and inflammation microscopically

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18
Q

hypothyroidism clinical features:

hair and skin -

thermogenesis -

fluid retention -

A

hair and skin -

coarse, sparse hair
dull, expressionless face
pale, cool, dougy skin
vitiligo
hypercarotenaemia

thermogenesis -

cold intolerance

fluid retention -

pitting oedema

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19
Q

hypothyroidism clinical features:

cardiac -

metabolic -

A

cardiac -

reduced HR
cardiac dilatation
pericardial effusion
worsening of heart failure

metabolic -

hyperlipidaemia
decreased appetite
weight gain

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20
Q

hypothyroidism clinical features:

GI -

respiratory -

neurological -

A

GI -

constipation
megacolon
ascites

respiratory -

deep hoarse voice
macroglossia - large tongue
obstructive sleep apnoea

neurological -

decreased intelligence

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21
Q

hypothyroidism clinical features:

gynae/reproductive -

A

hypothyroidism clinical features:

gynae/reproductive -

menorrhagia
later oligo- or amenorrhoea
hyperprolactinaemia

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22
Q

laboratory investigations of primary hypothyroidism - increased or decreased:

TSH
fT3/4
CK
LDL

A

TSH INCREASED
fT3/4 DECREASED
CK INCREASED
LDL INCREASED

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23
Q

hypothyroidism in younger patients management?

A

levothyroxine 50-100μg

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24
Q

hypothyroidism in elderly with IHD patients management?

A

levothyroxine 25-50μg

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25
Q

what should you check every 2 months after any dose change in hypothyroidism?

A

TSH

26
Q

once stabilised on levothyroxine, what should be checked every 12-18 months?

A

TSH

27
Q

levothyroxine is T3/T4

A

levothyroxine is T4

28
Q

when should levothyroxine be taken?

A

before breakfast

29
Q

in what situation is levothyroxine dose increased by 25-50%?

A

pregnancy as TBG increases

30
Q

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

mortality up to 60% despite early diagnosis and treatment

ECG: bradycardia, low voltage complexes, varying degrees of heart block, T wave inversion, prolongation of the QT interval

Type 2 respiratory failure: hypoxia, hypercarbia, respiratory acidosis
Co-existing adrenal failure is present in 10% of patients

diagnosis

A

myxoedema coma

31
Q

myxoedema coma treatment?

A

ABCDE

passively rewarm

32
Q

the clinical, physiological and biochemical state arising when the tissues are exposed to excess thyroid hormone defines what?

A

thyrotoxicosis

33
Q

conditions in which overactivity of the thyroid gland leads to thyrotoxicosis defines what?

A

hyperthyroidism

34
Q

thyrotoxicosis symptoms and signs?

CVS
sympathetic
CNS
GI
vision
hair and skin
reproduction
muscles
metabolism
thermogenesis
A

palpitations, AF, tremor, sweating, anxiety, nervousness, irritability, sleep disturbance, frequent loose bowels, lid retraction, double vision, proptosis, brittle thin hair, rapid fingernail growth, lighter and less frequent periods, muscle weakness, weight loss and increased appetite, heat intolerance

35
Q

name the most common condition associated with hyperthyroidism

A

graves disease

also hashitoxicosis, thyrotopinoma, cancer etc

36
Q

name the 2 different types of thyroid nodule

A

toxic solitary nodule

toxic multinodular goitre

37
Q

is thyroiditis like subacute thyroiditis, post-arum thyroiditis and amiodarone induced thyroiditis associated with hyperthyroidism?

A

no

38
Q

is smoking important in graves disease?

A

yes

graves is inflammatory disease so smoking doesn’t help

39
Q

in graves disease, increased or decreased:

TSH
fT4/3
ALP
calcium
WBC
A 
TSH - DECREASED
fT4/3 - INCREASED
ALP - INCREASED
calcium - INCREASED
WBC - DECREASED
40
Q

what bone disease is graves associated with?

A

osteoporosis

41
Q

name the antibody found in graves disease

A

TRAb

42
Q

name the condition of the legs seen in graves disease

A

pretibial myxoedema

43
Q

fingernail condition associated with graves?

A

thyroid acropachy

44
Q

large goitres in graves can result in a thyroid _____

A

large goitres in graves can result in a thyroid BRUIT

45
Q

name the main clinical finding of graves seen on the face

A

thyroid eye disease - TED
graves ophthalmopathy - GO

associated with smoking
TRAb driven

treated topically and with steroids in severe

46
Q

is TRAb positive or negative in nodular thyroid disease?

A

negative

47
Q

fT3/4 and TSH in nodular thyroid disease?

A

fT3/4 INCREASED

TSH DECREASED

48
Q

state the medical emergency associated with severe hyperthyroidism

A

thyroid storm

resp and cardio collapse
hyperthermia

49
Q

who is thyroid storm seen in?

A

hyperthyroid patients with an acute infection/illness or recent thyroid surgery

50
Q

thyroid storm treatment?

A 
Lugol’s Iodine
glucocorticoids
PTU
β-blockers
fluids
monitoring
51
Q

drug treatment of hyperthyroidism?

A

antithyroid drugs - ATDs

carbimazole - once daily

betablockers - propranolol for immediate symptomatic relief
caution in asthma so CCB instead

radioiodine - relapsed graves and nodular thyroid disease, contraindicated in pregnancy and high risk of hypothyroidism when used in graves

52
Q

drug treatment of hyperthyroidism in 1st trimester of pregnancy?

A

propylthiouracil

twice daily

53
Q

side effects of ATDs?

A

agranulocytosis - ATDs cannot be used again

rash, urticaria, jaundice, hepatic failure

54
Q

treatment of hyperthyroidism when radio iodine is contraindicated?

A

thyroidectomy

55
Q

what is subacute thyroiditis usually triggered by?

A

viral infection

56
Q

findings in subacute thyroiditis on scintigraphy scan?

A

low uptake throughout

57
Q

TSH is __________ and normal fT3/4 in ___________ hypothyroidism

TSH is __________ and normal fT3/4 in ___________ hyperthyroidism

A

TSH is INCREASED and normal fT3/4 in SUBCLINICAL hypothyroidism

TSH is DECREASED and normal fT3/4 in SUBCLINICAL hyperthyroidism

58
Q 
68 year old female
tired
weight gain
slow
goitre

diagnosis?

A

primary hypothyroidism

59
Q 
68 year old female
FHx of thyroid disease
tired
goitre
TSH high
T4 normal
TPO high

diagnosis?

A

subclinical hypothyroidism

60
Q 
52 year old male
headache
visual field defect
dizzy and weak
TSH low
T4 low

diagnosis?

A

pituitary tumour causing secondary hypothyroidism

Endocrinology (31 decks)

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