thyroid disease

Question 1

what is an excess of thyroid hormone?

Answer 1

hyperthyroidism

Question 2

what is a deficiency of thyroid hormone?

Answer 2

hypothyroidism

Question 3

which is more common, primary or secondary thyroid disease?

Answer 3

primary

secondary rare

Question 4

what are the causes of hyperthyroisism?

Answer 4

graves disease
-70-80% 
-auto antibodies stimulating the TSH receptor
toxic multi-nodular goitre
toxic adenoma
pituitary tumour

Question 5

what are the signs of hyperthyroidism?

Answer 5

warm moist skin
tachycardia & atrial fibrillation
increased bp and heart failure
tremor & hyperreflexia
eyelid retraction & lid lag

Question 6

what are the symptoms of hyperthyroidism?

Answer 6

hot
excess sweating
weight loss
diarrhoea
palpitations
muscle weakness
irritable, manic, anxious

Question 7

describe graves disease

Answer 7

organ specific autoimmune disease
goitre at base of neck
-enlarged thyroid gland
family history
opthalmopthy
conjunctival oedema

Question 8

what are the causes of primary hypothyroidism?

Answer 8

hashimoto's (90%)
idiopathic atrophy
raioiodine treatment/thyroidectomy
iodine deficiency
drugs
-cabimazole
-amiodarone
-litium
congenital

Question 9

what is the cause of secondary hypothyroidism?

Answer 9

hypothalamic/pituitary disease

Question 10

what are the signs of hypothyroidism?

Answer 10

dry coarse skin
bradycardia, hyperlipidaemia
psychiatric or confusion
goitre (hashimoto's)
delayed relflexes

Question 11

what are the symptoms of hypothyroidism?

Answer 11

tired
cold intolerance
weight gain
constipation
hoarse voice, goitre, puffy face/extremities
angina
slow/poor memory
hair loss

Question 12

describe hashimoto’s thyroiditis

Answer 12

middle aged/elderly women
associations
-family history of autoimmune disease

Question 13

describe idiopathic atrophy

Answer 13

increased incidence with age
10x more in females
likely autoimmune cause
-lymphocytes infiltrate
-associates with organ specific autoimmune disease

Question 14

how is thyroid disease investigated?

Answer 14

blood
-TSH, T3, T4
imaging
-ultrasound
-radioisotope scans
-show what areas of gland are producing/non-producing
tissue
-fine needle aspirate/biopsy

Question 15

what are the hormone levels in pituitary caused hyperthyroidism?

Answer 15

raised TSH

raised T3

Question 16

what are the hormone levels in graves/adenoma caused hyperthyroidism?

Answer 16

low TSH

raised T3

Question 17

what are the hormone levels in pituitary caused hypothyroidism?

Answer 17

low TSH

low T4

Question 18

what are the hormone levels in gland failure hypothyroidism?

Answer 18

high TSH

low T4

Question 19

what are the treatment options for hyperthyroidism?

Answer 19

carbimazole
-blocks and replace T4
beta-blockers
radioiodone
partial thyroidectomy

Question 20

what thyroid issue cannot be fixed?

Answer 20

graves opthalamopathy

graves changes in eye related to autoantibody not hormone

Question 21

what is the treatment for hypothyroidism?

Answer 21

T4 tablets-thyroxine
increase dose slowly
recheck using TSH as guide if gland failure

Question 22

describe goitre

Answer 22

diffuse enlargement of thyroid gland
often iodine deficient
diffuse, nodular

Question 23

describe solitary nodule enlargement

Answer 23

adenoma, carcinoma, cyst formation possible,
low cancer risk
sus in children/elderly

Question 24

describe thyroid cancer

Answer 24

usually with thyroid swelling
young/elderly
cold nodules on radioisotope scans
often TSH sensitive- T4 post surgery
good prognosis in young
80% 10 year mortality in folicular

Question 25

what are dental aspects of thyroid disease?

Answer 25

goitre detectable
hyperthyroid
-pain anxiety and psychiatric problems
-caution for tx until controlled
hypothyroid
-avoid using sedatives if severe
treated=normal