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203 theme 1 > 8. Thyroid Disease > Flashcards

8. Thyroid Disease Flashcards

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1
Q

hypothyroidism

A

underproduction of thyroid hormone
primary = due to thyroid problem
secondary = due to hypothalamic/pituitary problem

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2
Q

hyperthyroidism

A

thyrotoxicosis

overproduction of thyroid hormone

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3
Q

euthyroid

A

normal production of thyroid hormone

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4
Q

goitre

A

enlargement of thyroid gland

patient would be hyper, hypo or euthyroid

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5
Q

how to examine thyroid

A 
low down in neck, feel for thyroid cartilage - down and laterally 
moves on swallowing
listen to bruit (increased blood flow)
retrosternal extension
check cervical lymph nodes
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6
Q

thyroid function tests

A

TSH, FT4, FT3

thyroid antibodies - anti-TPO (thyroid peroxidase), TRAB-TSH receptor

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7
Q

TSH

A

best biomarker of thyroid status
slow to respond to change
assumes normal pituitary function
negative feedback regulation

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8
Q

thyroid autoantibodies

A

different types: destructive or stimulatory

marker of risk for autoimmune condition

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9
Q

hypothyroidism symptoms

A 
may be none
lethargy
mild weight gain
cold intolerance
constipation
facial puffiness
dry skin
hair loss
hoarseness 
heavy menstrual periods
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10
Q

signs of severe hypothyroidism

A 
change in appearance (face puffy and pale) 
preorbital oedema 
dry, flaky skin 
diffuse hair loss
bradycardia
carpal tunnel (median nerve compression
effusions
croaky voice
goitre 
delayed relaxation of reflexes
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11
Q

causes of primary hypothyroidism

A 
autoimmune hypothyroidism 
hypothyroidism after treatment for hyperthyroidism (iatrogenic)
thyroiditis 
drugs 
congenital hypothyroidism 
iodine deficiency
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12
Q

causes of secondary hypothyroidism

A

rare

diseases of hypothalamus or pituitary

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13
Q

hypothyroidism investigations

A

blood tests to confirm - TSH high, FT4 low
could check thyroid antibodies
no imaging necessary

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14
Q

hypothyroidism treatment

A

daily thyroxine

aim = normal FT4 without TSH suppression

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15
Q

autoimmune hypothyroidism

A

chronic autoimmune thyroiditis - hashimoto’s

myxoedema (coma)

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16
Q

myxoedema

A

accumulation of glycosaminoglycans in interstitial spaces of tissues
occurs in very severe hypothyroidism
coma

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17
Q

thyrotoxicosis symptoms

A 
weight loss
lack of energy 
heat intolerance 
anxiety/irritability 
increased sweating 
increased appetite 
thirst
palpitations 
pruritus 
weight gain 
loose bowels 
oligomenorrhora
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18
Q

signs of severe thyrotoxicosis

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A 
tremor 
warm, moist skin 
tachycardia
brush reflexes 
eye signs 
thyroid bruit 
muscle weakness 
atrial fibrillation
19
Q

thyroid eye disease (TED) and thyroid associated opthalmopathy (TAO)

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A 
associated with Grave's in ~20% 
increased risk in smokers 
antibody mediated 
inflammation of all orbital tissues except eye (fat, muscles, conjunctiva, eyelids) 
CT scan imaging helpful
20
Q

TED/TAO mild symptoms

Study These Flashcards
A

itchy/dry eyes

prominent eyes, change in appearance

21
Q

TED/TAO worrisome symptoms

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A 
diplopia/loss of sight 
loss of colour vision
redness/swelling of conjunctiva 
unable to fully close eyes
ache/pain/tightness in or behind eye
22
Q

signs associated with thyrotoxicosis - hands

Study These Flashcards
A

fine tremor

warm, moist

23
Q

signs associated with thyrotoxicosis - pulse

Study These Flashcards
A

sinus tachycardia

atrial fibirillation

24
Q

signs associated with thyrotoxicosis - neck

Study These Flashcards
A

goitre
move when swallow
smooth/not
bruit/not

25
signs associated with thyrotoxicosis - eyes
lid retraction/lag proptosis/exopthalmos opthalmoplegia (abnormal eye movements, causes diplopia) inflammation (of conjunctiva)
26
causes of thyrotoxicosis
``` autoimmune hyperthyroidism (Grave's) toxic multi nodular goitre toxic adenoma thyroiditis drugs (eg amiodarone) gestational ```
27
Grave's disease
autoantibody stimulates TSH receptor causes excess thyroid hormone production and thyroid growth (goitre) accounts for 70% cases
28
gestational thyroiditis
placental beta-hCG is structurally similar to TSH - has similar action on thyroid more likely if hyperemesis/twins settles after 1st trimester
29
Grave's - helpful diagnostic features
personal or family history of any autoimmune endocrine disease goitre with bruit thyroid eye disease positive thyroid antibody titre
30
hypothyroidism investigations
low TSH, high FT3 and FT4 thyroid antibodies may not need imaging thyroid uptake scan (isotype test)
31
Grave's treatment options
medical radioiodine surgery
32
risks of untreated Grave's
symptoms worsen atrial fibrillation osteoporosis
33
Grave's - medical treatment
``` carbimazole of propylthiouracil 18 months-2 years rare side effect = agranulocytosis ~1/3 cure rate 2/3 relapse: usually in first year ```
34
Grave's - radioiodine treatment
oral - radioiodine concentrates in thyroid, radiation kills thyroid cells medical treatment used until euthyroid ~40% risk fo hypothyroidism after must avoid close treatment for 1-2 weeks after not if severe thyroid eye disease
35
Grave's - surgery
subtotal thyroidectomy (almost total) patients must be euthyroid post-op medical therapy first risks: anaesthetic, neck scar, hypothyroidism, hypoparathyroidism, vocal cord palsy
36
toxic adenoma/multinodular goitre treatment
initially: short term medical therapy | subsequent curative treatment: radioiodine
37
thyroid eye disease treatment
encourage smoking cessation steroids/other immunosuppressives radiotherapy surgical treatment: orbital decompression, eyelid surgery
38
thyroid storm
thyrotoxic crisis rare, usually occurring in 2nd degree Grave's incomplete treatment - erratic compliance, start-stop, early in treatment high mortality rate, ITU level care
39
features of thyroid storm
``` multi-system Grave's hyperpyrexia CNS - agitation, delirium CV - tachycardia, ventricular dysfunction, heart failure GI - nausea, vomiting, diarrhoea ```
40
thyroiditis
usually self-limiting inflammation of thyroid transient mild: always resolves 1-2 months longer hypothyroid phase: 4-6 months, 80% after 1 year
41
autoimmune endocrine diseases associated with thyroid disease
``` type 1 diabetes pernicious diabetes coeliac anaemia coeliac disease premature ovarian failure Addison's disease ```
42
syndromes associated with thyroid disease
Turner syndrome | Down's syndrome
43
euthyroid goitre
common more common in iodine deficient areas may be multi-nodular usually nothing to worry about
44
thyroid nodule
must exclude cancer (~5%) ultrasound characteristics helpful fine-needle aspiration biopsy for cytology

203 theme 1 (16 decks)

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