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Year 2- Endocrine System > Clinical Thyroid Disease > Flashcards

Clinical Thyroid Disease Flashcards

1
Q

What is the name given to the part of the thyroid gland which connects the right and left lobe?

A

Isthmus

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2
Q

Explain how thyroid function is controlled.

A

Hypothalamus produces TRH.
TRH acts on anterior pituitary.
Stimulates production of TSH.
Thyroid produces T3, the active component.

There is a negative feedback system so if there’s too much of anything, it can loop back and turn the production of the cycle off.

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3
Q

If the source of an endocrine condition is at the thyroid gland, what is this called?

A

Primary hypothyroidism

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4
Q

If the source of an endocrine condition is at the pituitary gland, what is this called?

A

Secondary hypothyroidism

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5
Q

List some of the symptoms of hypothyroidism.

A

Fatigue/lethargy
Cold intolerance
Weight gain
Non-specific weakness
Constipation
Depression
Dry skin
Thyroid pain

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6
Q

List some of the signs of hypothyroidism.

A

Coarse, dry hair
Skin and hair loss
Oedema
Vocal changes
Goitre
Bradycardia and diastolic hypertension
Delayed reflexes
Paraesthesia

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7
Q

What tests would you do if you suspected hypothyroidism?

A

Check TFT (thyroid function tests)
Possibly FBC and glucose too

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8
Q

What does TFT’s check for?

A

TSH
Free T4

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9
Q

In those with hyperthyroid disease, what are T3/4 levels like?

A

Increased

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10
Q

In those with hyperthyroid disease, what are TSH levels like?

A

Decreased

->too much TH so not releasing anymore

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11
Q

In those with hypothyroid disease, what are T3/4 levels like?

A

Decreased

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12
Q

In those with hypothyroid disease, what are TSH levels like?

A

Increased

->to try and release more TH

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13
Q

Which medication can be used to help in the treatment of hypothyroidism?

A

Levothyroxine

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14
Q

In adults <65 with hypothyroidism, how much levothyroxine should be given?

A

1.6 mcg per kg

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15
Q

In adults >65 or with pre-existing cardiac disease and hypothyroidism, how much levothyroxine should be given?

A

More cautious levels- 25-50mcg

->more cautious as medication can rapidly increase HR

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15
Q

At what point in the day should levothyroxine be taken?

A

First thing in the morning on an empty stomach

->if unable, late evening, at least two hours after meal

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16
Q

List the signs/symptoms of hypothyroidism.

A

Weight gain
Lethargy
Feeling cold
Constipation
Heavy periods
Dry skin/hair
Bradycardia
Slow reflexes
Goitre

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17
Q

List the signs/symptoms of hyperthyroidism.

A

Weight loss
Anxiety/irritability
Heat intolerance
Bowel frequency
Light periods
Sweaty palms
Palpitations
Hyperreflexia
Goitre
Thyroid eye symptoms

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18
Q

What is the most common endocrine condition?

A

Diabetes

-> hypothyroidism is the second most common

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19
Q

What is the most common cause of primary hypothyroidism?

A

Congenital- either developmental or dyshormonogenesis (hormones not getting produced or released)

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20
Q

If hypothyroidism isn’t diagnosed and treated quickly, it can lead to physical and mental retardation. How is this prevented?

A

Every baby screened in UK

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21
Q

What are some of the causes of acquired hypothyroidism?

A

Autoimmune thyroid disease
Iatrogenic cause
Chronic iodine deficiency
Post-subacute thyroiditis

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22
Q

Give an example of an autoimmune thyroid disease which can cause acquired hypothyroidism?

A

Hashimotos

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23
Q

List some causes of secondary/tertiary hypothyroidism.

A

Pituitary tumour
Post pituitary surgery/ radiotherapy

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24
Q

Suppressed TSH has an increased risk of what?

A

Atrial fibrillation
Osteopenia
Fracture

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25
Q

What is subclinical hypothyroidism?

A

Elevated TSH to ensure that FT3/4 levels are normal

->therefore, the pituitary gland is working a lot harder

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26
Q

What are some of the causes of primary hyperthyroidism?

A

Grave’s disease
Toxic Multinodular Goitre
Toxic adenoma

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27
Q

What is another term for hyperthyroidism?

A

Thyrotoxicosis

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28
Q

What is usually the cause of secondary hyperthyroidism?

A

Pituitary adenoma secreting TSH

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29
Q

What is meant by thyrotoxicosis without hyperthyroidism?

A

Thyroid gland itself is not producing excess TH, it is due to destructive thyroiditis

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30
Q

What causes the majority of cases of hyperthyroidism?

A

70-80%

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31
Q

What is Grave’s disease?

A

An autoimmune driven condition in which stimulating antibodies stimulate the thyroid gland to overproduce TH

32
Q

Which antibodies in Grave’s disease stimulate the thyroid gland to overproduce TH?

A

TSH receptor antibodies

33
Q

How is a diagnosis of Grave’s disease made?

A

When patient has hyperthyroidism and is thyroid receptor antibody positive

34
Q

What is the most common cause of thyrotoxicosis in the elderly?

A

Multi-nodular goitre

35
Q

Who is more likely to be affected by subacute thryoiditis?

A

Younger patients <50yrs

36
Q

What often triggers subacute thyroiditis?

A

Viral trigger

37
Q

What are the symptoms of subacute thyroiditis?

A

Painful goitre
Fever/myalgia
ESR increased

38
Q

Which medications are given to those with subacute thyroititis?

A

Short terms steroids and NSAIDs

39
Q

What are the three treatment options for hyperthyroidism?

A

Antithyroid drugs
Radioiodine
Surgery

->antithyroid drugs do not cure the condition but are a holding measure

40
Q

Which type of drug can be used to reduce some of the manifestations of hyperthyroidism e.g. tremors, tachycardia, palpitations?

A

Beta blockers

41
Q

Give two examples of antithyroid drugs.

A

Carbimazole
Propylthiouracil

42
Q

What are some of the side effects of antithyroid drugs?

A

Rash
Agranulocytosis*- serious

-> * deficiency of granulocytes in the blood, causing increased vulnerability to infection.

43
Q

What should be done if a patient on antithyroid drugs has a severe sore throat or mouth ulcers or infections out of the ordinary?

A

FBC

44
Q

In selected cases of hyperthyroidism, long term low does antithyroid drugs may be used. Give some examples of patients who may be treated using this option

A

Elderly
Those with cardiac complications
Patients who are unwilling for radioiodine or surgery

45
Q

What can radioiodine cause as a result?

A

Hypothyroidism

46
Q

What are some of the negatives of radioiodine?

A

Stays in thyroid glad for four weeks but anyone the patient comes into contact with is exposed to radiation from the radioiodine.
Can trigger eye disease

->worth warning that the radiation can set off security alarms in airports for a couple of months

47
Q

What line of treatment if radioiodine usually?

A

Usually second line of treatment

48
Q

A 38yo women with two children has a reoccurrence of Graves hyperthyroidism. What would be the probable choice of treatment?

A

Surgery

->not radioiodine as would expose her children to radiation

49
Q

What is subclinical hyperthyroidism?

A

TSH supressed but normal free TH

50
Q

What are some of the concerns of subclinical hyperthyroidism?

A

Decreases bone density
Can increase risks of AF

51
Q

What are the treatment options for subclinical hyperthyroidism?

A

If persistent, antithyroid drugs or radioiodine to treat, especially those who are elderly or those w increased cardiac risk

52
Q

There is a genetic condition called RTH (resistance to TH). What are FT3/4 levels and TSH levels like in this condition?

A

TSH normal or slightly elevated
FT3/4 elevated

53
Q

Goitre?

A

Swelling of the thyroid gland

54
Q

What are some of the physiological causes of goitre?

A

Puberty
Pregnancy

55
Q

What are some of the autoimmune causes of goitre?

A

Graves disease
Hashimoto’s disease

56
Q

What are some of the thyroiditis related causes of goitre?

A

Acute/ de Quervain’s
Chronic fibrotic/Reidel’s

57
Q

What are some of the other causes of goitre?

A

Iodine deficiency
Dyshormogenesis
Goitrogens- medications blocking the formation of thyroid hormones

58
Q

List some of the different types of goitre.

A

Multinodular
Diffuse
Cysts
Tumours
Miscellaneous

59
Q

What is a single nodule in the thyroid known as?

A

Solitary nodule

60
Q

Who is at increased risk of malignancy via a solitary nodule of the thyroid?

A

Children
Adults <30 or >60
Previous head and neck irridation

61
Q

What % chance is there that the solidary nodules of the thyroid turn malignant?

A

5%

62
Q

Which investigations are used for investigating solitary nodule of the thyroid?

A

TFT’s
Ultrasound- to differentiate between benign and malignant
Fine needle aspiration

63
Q

What is the usual first line investigation of solitary thyroid nodules?

A

Ultrasound

-> then if ultrasound is suspicious, FNA carried out

64
Q

Thyroid cancer can be termed as differentiated or undifferentiated.
Name the two classicisation’s of differentiated thyroid cancer.

A

Papillary
Follicular

65
Q

Which type of differentiated thyroid cancer is more common?

A

Papillary

66
Q

Describe papillary thyroid cancer.

A

Commonest
Multifocal, local spread to lymph nodes

67
Q

Describe follicular thyroid cancer.

A

Usually a single nodule
Metastases to lung/bone

68
Q

Differentiated thyroid cancer usually has a good prognosis.
What are some of the factors in which prognosis is likely to be poorer?

A

Age <16 or >55
Bigger tumour size
Spread outwith thyroid capsule

69
Q

What is the treatment for thyroid cancer?

A

Near total thyroidectomy

-> if high risk, high dose radioiodine would be considered

70
Q

Those who have had thyroid cancer will have to be on long term doses of what?

A

Long term suppressive doses of thyroxine

71
Q

What is the marker for thyroid cancer?

A

Thyroglobulin

72
Q

What treatment is used if it is thought that the thyroid cancer has a high chance of spreading?

A

Radioiodine ablation

73
Q

Describe anaplastic thyroid cancer

A

Aggressive and locally invasive
Very poor prognosis
Does not respond to radioiodine

74
Q

Describe thyroid lymphoma.

A

Rare, may arise from pre-existing Hashimotos.
External RT more helpful, combined with chemo

75
Q

In medullary thyroid cancer, where does the tumour arise from?

A

Parafollicular C cells

76
Q

What is medullary thyroid cancer often associated with?

A

MEN 2

77
Q

What is the treatment for medullary thyroid cancer?

A

Total thyroidectomy

-> no role for radioiodine

78
Q
A

Year 2- Endocrine System (27 decks)

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