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Year 2 MBChB Endocrine > Thyroid Disease > Flashcards

Thyroid Disease Flashcards

1
Q

Name the 2 main causes of gland hyperfunction.

A

Tumour

Hyperplasia

Anything which increases cell number/function

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2
Q

Name 4 causes of gland hypofunction?

A

Infection

Autoimmunity

Ischemia

Tumour

Anything which decreses cell number/function

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3
Q

What are the 2 main pathologies of secondary hyper/hypothyroidism?

A

Hypothalmic disease

Pituitary disease

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4
Q

Name 5 causes of hyperthyroidism/thyrotoxicosis starting with the most common.

A

Grave’s disease

Toxic multinodular goitre

Tumours

Thyroiditis

High iodine intake

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5
Q

What is primary and secondary hyperthyroidism profile in terms of TSH and T3/T4?

A

Primary = low TSH and high T3/T4

Secondary = normal or raised TSH and high T3/4

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6
Q

List general signs of hyperthyroidism.

A

Palpitations

Tremour

Weight gain

Anxiety

Heat intolerance

Eye disease

Pretibial myxoedema

Thyroid acropachy

Goitre

Brittle hair

Oligo/ame/polymenorrhea

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7
Q

How does hyperthyroidism present in teenage girls?

A

Behvioural, sleeping and eating issues

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8
Q

Name the drug used for hyperthyroidism in normal pateints vs 1st trimester pregnancy.

A

Carbimazole

Propylthiouracil (PTU)

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9
Q

How does carbimazole + PTU work?

A

Carbimazole = blocks TPO to stop T3/4 production

PTU = blocks DIO1

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10
Q

Name a side effect of PTU.

A

Liver failure

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11
Q

Name 4 side effects of carbimazole.

A

Agranulocytosis

Jaundice

Neutropenia

Aplasia cutis

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12
Q

Name 3 red flag signs for agranulocytosis.

A

Sore throat

Ulcer

Fever

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13
Q

Describe the 3 stepwise treatment of hyperthyroidism.

A

Beta-blockers + carbimazole or PTU

Radioiodine

Total thyroidectomy

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14
Q

Name 2 ways to administer anti-thyroid drugs.

A

Titrate and reduce carbimazole by TFTs every 1-2 months

Give carbimazole + levothyroxine together

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15
Q

Name 2 complications of thyroid surgery.

A

Recurrent laryngeal nerve damage

Hypothyroidisim

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16
Q

Name 4 signs of thyroid eye disease.

A

Exopthalmos/proptosis

Diplopia

Gritty eyes

Lid lag

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17
Q

What is the triad of thyroid acropachy?

A

Clubbing

Hands and feet swelling

Periosteal bone formation

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18
Q

What is Grave’s disease and who is it more common in?

A

Autoimmune hyperthyroidism

Women

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19
Q

Name 3 autoantibodies associated with Grave’s starting with the specific one + what letter they are.

A

Anti-TRAb

Anti-TPO

Anti-thyroglobulin

IgG antibodies

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20
Q

Explain how Grave’s disease works.

A

Anti-TRAb acts like TSH and activates T3/T4 production

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21
Q

Name 4 risk factors for Grave’s disease.

A

Smoking

Family history

Stress

Infection

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22
Q

Name 3 complications of Grave’s disease.

A

Osteoporosis

Hypercalcemia

Leukopenia

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23
Q

What does this show?

A

Normal thyroid

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24
Q

What does this show?

A

Grave’s disease

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25
Q

Which 2 groups is toxic multinodular goitre commonly seen in?

A

Eldery

Iodine-deficient

26
Q

What is toxic multinodular goitre?

A

Autonomous nodules acting independently of TSH

27
Q

What does this show?

A

Toxic multinodular goitre

28
Q

What is a thyroid storm?

A

Medical emergency of severe hyperthyroidism

29
Q

Name 3 causes of severe hyperthyroidism.

A

Infection

Post-surgery

Post-radioiodine

30
Q

Name 3 signs of a thyroid storm.

A

Respiratory/cardaic collpase

Hyperthermia

Excessive reflexes

31
Q

What are the 4 main part to thyroid storm treatment?

A

PTU

Lugol’s iodine

Steroids

Beta-blockers

32
Q

What is subclinical hyperthyroidism and what is it commonly seen with?

A

Decreased TSH with normal T3/4

Multinodular goitre

33
Q

What is the risk of subclinical hyperthyroidism + name 2 associations.

A

Hyperthyroidism

Osteoporosis and AF

34
Q

Treatment indications for subclinical hyperthyroidism?

A

Treat if TSH < 0.1, AF or osteoporosis

35
Q

What is subclinical hypothyroidism?

A

Increases TSH with normal T3/T4

36
Q

What is the risk of subclinical hypothyroidism + risk factor?

A

Hypothyroidism

Anti-TPO +ve

37
Q

Treatment indications for subclinical hypothyroidism?

A

Treat if TSH > 10 but ALWAYS if pregnant

38
Q

What is sick euthyroid illness, who is it seen in and what is the characteristic biochemical trend?

A

Non-thyroidal ilness causing suppressed TSH

Unwell patients

TSH rises during recovery

39
Q

Should you regularly check TFTs if suspected sick euthryoid syndrome?

A

No - avoid checking TFTs

40
Q

What is primary and secondary hypothyroidism profile in terms of TSH and T3/4?

A

Primary = high TSH with low T3/4

Secondary = normal or low TSH with low T3/4

41
Q

Name 4 causes of hypothyroidism starting with the most common

A

Hashimoto’s thyroiditis

Iodising radiation

Surgery

Iodine deficiency

42
Q

Name 3 examples of each of goitrous, non-goitrous and self-limiting primary hypothyroidism.

A

Goitrous = Hashimoto’s thyroiditis, iodine deficiency, drugs

Non-goitrous = atrophic thyroiditis, post-surgery, irradiation

Self-limiting = subacute thyroiditis, post-partum, drug withdrawal

43
Q

What is the most common cause of secondary hypothyroidism?

A

Hypothalamic or pituitary disease

44
Q

List general signs of hypothyroidism.

A

Bradycardia

Fatigue

Depression

Cold intolerance

Myxoedema

Weight gain

Hair loss

Vitiligo

Oligo/ame/polymenorrhea

45
Q

What is the effect of hypothyroidism in children?

A

Cretinism

46
Q

What effect does hypothyroidism have on lipids and CK?

A

Increases them

47
Q

What is a myxoedema coma, who is it seen in + treatment?

A

Medical emergency of sever hypothyroidism

Elderly pateints with history of illness

IV T3 + steroids

48
Q

Treatement regime for young and elderly with hypothyroidism?

A

Young = levothyroxine 50-100 micrograms

Elderly = levothyroxine 25-50 micrograms adjusted every month

49
Q

Monitoring for hypothyroidism?

A

Check TSH every 2 months after starting medication

Check TSH ever 12-18 months when stable

50
Q

What does this show?

A

Hypothyroidism (thyroiditis)

51
Q

Treatment regime for secondary hypothyroidism?

A

Titrate levothyroxine to T4 levels

Build up gradually to prevent ischaemia

52
Q

What is the antibody specfic to Hashimoto’s thyroiditis?

A

Anti-TPO

53
Q

Who is subactute/De Quervain’s thyroiditis seen in?

A

Younger patients with viral illness

54
Q

Name 2 drugs which cause thyroiditis and explain how they do so?

A

Amiodarone and lithium

Inhibits DIO1 to reduce T3/T4 production

55
Q

What is Hashimoto’s thyroiditis + 2 genetic links + main antibody?

A

Autoimmune failure of thyroid gland

DR3 and DR5 genes

Anti-TPO

56
Q

Who is Hashimoto’s thyroiditis seen in most?

A

Middle-aged women

57
Q

What is the main risk of Hashimoto’s thyroiditis?

A

B cell Non-Hodkin lymphoma

58
Q

What is Hashitoxicosis?

A

Transient hyperfunction of thyroid followed by Hashimoto’s thyroiditis

59
Q

How is congenital hypothyroidism screened for?

A

Guthrie test (heel prick on day 5)

60
Q

Name 2 causes of congenital hypothyroidism.

A

Abnormal thyroid site

Pituitary dysfunction

61
Q

Name 3 signs of congenital hypothyroidism.

A

Delayed jaundice

Poor feeding

Hypotonia

62
Q

What is dyshormonogenesis?

A

AR genetic defect in T3/4 metabolism

Year 2 MBChB Endocrine (14 decks)

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