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Endo- thyroid disorders Flashcards

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1
Q

what is hyperthyroidism

A

refers specifically to the conditions in which overactivity of the thyroid gland lead to thyrotoxicosis

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2
Q

most common cause of hyperthyroidism (85% of cases)

A

Graves disease

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3
Q

graves disease more common in females/males

A

females (10:1)

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4
Q

in graves disease, which receptor antibodies stimulate the thyroid

A

anti-TSH

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5
Q

general symptoms of hyperthyroidism

A

weight loss despite increased appetite
frequent, loose bowel movements
sweating and heat intolerance
goitre (swelling in neck)- diffuse, toxic

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6
Q

what is a goitre

A

enlarged palpable thyroid gland, which moves on swallowing

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7
Q

CVS symptoms of hyperthyroidism

A

increased pulse rate
palpitations, AF
rarely cardiac failure

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8
Q

what is graves eye disease associated with

A

smoking

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9
Q

what produces the TSH

A

the pituitary gland (located in the brain)

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10
Q

primary hyperthyroidism thyroid hormone levels

A

TSH low
T3/T4 high

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11
Q

thyroid autoantibodies in graves disease

A

TSH receptor antibody (70-100%)
Anti-TPO antibody (70-80%)
Anti-thyroglobulin antibody (30-50%)

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12
Q

1st line medical management in graves disease

A

carbimazole

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13
Q

what is a thyroid storm

A

rapid deterioration of hyperthyroidism with:
hyperpyrexia
severe tachycardia
extreme restlessness
cardiac failure
liver dysfunction

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14
Q

immediate symptomatic relief of thyrotoxicosis symptoms

A

beta blockers

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15
Q

preferred antithyroid medication in first trimester of pregnancy

A

PTU

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16
Q

what is hypothyroidism

A

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

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17
Q

symptoms of hypothyroidism

A

tiredness/malaise
weight gain, despite < appetite
cold intolerance
< sweating
constipation
bradycardia

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18
Q

primary hypothyroidism hormone levels

A

TSH high
T4 and T3 low

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19
Q

Thyroid antibodies in autoimmune hypothyroidism

A

anti-TPO antibody
antithyroglobulin
TSH receptor antibody

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20
Q

when does graves disease usually present

A

20-40 years

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21
Q

sign of graves disease, associated only with large goitres

A

thyroid bruit

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22
Q

systemic symptoms associated with hyperthyroidism

A

double vision
cardiac- palpitations, tachycardia
msk- muscle weakness thighs and upper arms
neuro- increased nervousness, sleep disturbance, depression
hair and skin- thin brittle hair, rapid fingernail growth
reproductive- lighter and less frequent periods

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23
Q

first choice treatment in relapsed graves disease

A

radioiodine

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24
Q

what treatment is useful for relapsed graves disease when radio iodine is contraindicated eg pregnancy

A

thyroidectomy

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25
who are thyroid storms typically seen in
hyperthyroid patients with an acute illness/infection or recent thyroid surgery
26
causes of congenital hypothyroidism
absent or underdeveloped thyroid gland dyshormonogenesis iodine deficiency during pregnancy maternal use of antithyroid drugs
27
what is the most common cause of primary hypothyroidism in iodine-sufficient regions
hashimoto's thyroiditis (chronic lymphocytic thyroiditis)
28
what are the risk factors for hashimotos thyroiditis
middle age women (45-60 years) family history of autoimmune thyroid disease associated with HLA-DR3 and DR5
29
what is the most common type of primary hypothyroidism worldwide
iodine deficiency
30
what are iatrogenic causes of primary hypothyroidism
post-radioiodine therapy thyroid surgery certain drugs (eg lithium, amiodarone)
31
what causes secondary hypothyroidism
pituitary disorder resulting in TSH deficiency
32
what causes tertiary hypothyroidism
hypothalamus disorders causing TRH deficiency
33
what is Hashimoto's thyroiditis
autoimmune condition causing gradual destruction of the thyroid gland, leading to hypothyroidism
34
what antibodies are characteristic of hashimotos thyroiditis
anti-thyroglobulin anti-thyroid peroxidase (TPO antibodies)
35
how does hashimotos thyroiditis cause thyroid cell destruction
antibody-dependent cell-mediated cytotoxicity CD8 + T cell mediated destruction cytokine-mediated apoptosis
36
what is hashitoxicosis
a transient hyperthyroid phase that may precede the hypothyroid state in hashimotos thyroiditis
37
what do hurthle cells look like
large, pink (eosinophilic), puffy cells
38
what are the key histological features in hashimotos thyroiditis
lymphocytes and germinal centre thyroid follicles atrophy hurthle cells may see progressive fibrosis
39
Symptoms related to generalised myxoedema (severe hypothyroidism)
doughy skin texture, puffy appearance
40
what heart issues are related to Myxoedema
dilated cardiomyopathy bradycardia pericardial effusion dyspnoea worsening heart failure
41
which type of oedema is seen in hypothyroidism
periorbital oedema (around the eyes)
42
What is pretibial myxoedema?
swelling on the shins seen in hypothyroidism and graves disease
43
what is a common entrapment syndrome in myxoedema
carpal tunnel syndrome
44
what neurological symptoms may occur with myxoedema
peripheral neuropathy
45
what happens to the tongue in myxoedema
macroglossia- enlarged tongue
46
how does the voice change in myxoedema
deep, hoarse voice
47
what severe condition can result from untreated myxoedema
myxoedema coma
48
goitres can be found in both hyper and hypothyroidism true/false?
true
49
common abnormalities found in primary hypothyroidism
macrocytosis (>MCV) elevated creatine kinase elevated LDL cholesterol hyponatraemia hyperprolactinaemia
50
treatment of primary hypothyroidism in younger patients
start levothyroxine 50-100ug daily and gradually increase
51
treatment of primary hypothyroidism in elderly patients with history of IHD
start levothyroxine 25-50ug daily, adjusted every 4 weeks
52
what is the mortality of myxoedema coma
60%
53
who do myxoedema comas typically affect
elderly women with long standing but frequently unrecognised or untreated hypothyroidism
54
what is queen annes sign in hashimotos thyroiditis
loss of lateral third of eyebrow
55
treatment of myxoedema coma
IV hydrocortisone and IV levothyroxine
56
what is De Quervains thyroiditis
describes the presentation of a viral infection with fever, neck pain and tenderness, dysphagia and features of hyperthyroidism
57
which ages are most commonly affected by de quervains thyroiditis
20-50
58
clinical features of de quervains thyroiditis
painful, diffuse, firm goitre fever and/or malaise may be present hyperthyroid phase followed by hypothyroid phase
59
management of de quervains thyroiditis
supportive treatment
60
drugs that can induce thyroiditis
amiodarone lithium
61
what is subclinical thyroid disease
abnormal TSH with normal thyroid hormone
62
treat subclinical hypothyroidism when TSH is over what?
TSH>10
63
subclinical hyperthyroidism often seen in what
multi-nodular goitre
64
what is subclinical hyperthyroidism associated with
osteoporosis atrial fibrillation
65
treat subclinical hyperthyroidism when TSH is under what?
<0.1%
66
solitary thyroid nodules affect what percentage of women
5%
67
what percentage of solitary thyroid nodules are benign
95%
68
examples of benign thyroid nodules
cyst colloid nodule benign follicular adenoma hyperplastic nodule
69
clinical features of solitary thyroid nodules
lump moves on swallowing majority are painless signs of malignancy- enlarged lymph nodes, hoarseness
70
what does a U2 classification on thyroid USS mean
benign nodule
71
from which USS classification of thyroid is FNA (fine-needle aspiration) recommended
U3 and above (U3=atypical)
72
what does U4 classification on thyroid USS suggest
probably malignant
73
what does U5 classification on thyroid USS suggest
malignant
74
what does Thy1 mean on the FNA Bethesda classification
inadequate sample
75
what does Thy2 indicate in the Bethesda classification
benign result
76
what does Thy3 indicate in the Bethesda classification
Atypical (suspicious, but not clearly malignant)
77
what does Thy4 indicate in the Bethesda classification
Probably malignant
78
what does Thy5 indicate in the Bethesda classification
malignant
79
effects of thyroid during pregnancy-
increased demand on thyroid- enlarged thyroid increased T4 production
80
postpartum thyroiditis affects what percentage of post part women
5% (25% in T1DM)
81
which type of thyroid cancer is associated with hashimotos
papillary carcinoma
82
what age group of patients usually develop anaplastic carcinomas
elderly
83
which is more aggressive- medullary/anaplastic carcinomas
anaplastic carcinomas
84
what test is screened regularly after medullary carcinomas
serum calcitonin
85
which type of thyroid cancer carries the worst prognosis
anaplastic carcinoma
86
what is the least common type of thyroid cancer
anaplastic carcinoma

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