Endocrinology - The Thyroid Flashcards
(87 cards)
1
Q
What is a goitre
A
Painless enlargement of the thyroid gland
2
Q
DDx diffuse goitre - physiological
A
Puberty
Pregnancy
3
Q
DDx diffuse goitre - autoimmune
A
Grave’s
Hashimoto’s
4
Q
DDx diffuse goitre - thyroiditis
A
De Quervains
Rediel’s thyroiditis
5
Q
DDx diffuse goitre - drugs (4)
A
Antithyroid Dx
Lithium
Iodine excess
Amiodarone
6
Q
Multinodular goitre DDx
A
Toxic multinodular goitre
Subacute thyroiditis
7
Q
Solitary nodule goitre DDx (5)
A
Follicular adenoma Benign nodule Thyroid malignancy Lymphoma Metastasis
8
Q
Infiltration nodular goitre cause
A
TB
Sarcoid
9
Q
Ix thyroid swelling (7)
A
FBC (anaemia) ESR TFT Thyroid autoantibodies CT neck/thorax USS FNAC
10
Q
When would treatment be required on a euthyroid pt with a goitre? (3)
A
Cosmesis
Possibility of malignancy
If causing pressure Sx
11
Q
M:F Thyrotoxicosis
A
1:5 M:F
12
Q
Causes thyrotoxicosis (7)
A
Graves Toxic multinodular goitre Solitary toxic adenoma Thyroiditis Dx induced XS iodine intake Hashitotoxicosis
13
Q
Who gets toxic multinodular goitre
A
Older women
14
Q
What is Plummers disease
A
Toxic multinodular goitre
15
Q
Drugs that induce thyrotoxicosis (2)
A
amiodarone
XS levothyroxine
16
Q
Rare 2’ causes thyrotoxicosis (2)
A
TSH secreting pit adenoma
Resistance to thyroid hormone
17
Q
Sx hyperthyroidism (7)
A
Weight loss Increased appetite Irritability Restlessness Tremor Heat intolerance Palpitations
18
Q
Signs hyperthyroidism (9)
A
Tremor Hyperkinesis TachyC/AF Full pulse Warm vasodilated peripheries Exophthalmos Lid lag/stare Goitre/bruit Thyroid acropachy
19
Q
Grave’s ophthalmology (4)
A
Lagophthalmos
Exophthalmos
Ophthalmoplegia
Periorbital oedema
20
Q
Mortality rate thyroid storm
A
10%
21
Q
What causes thyroid storm? (5)
A
Period of stress Infection Surgery Childbirth Untx/uncontrolled hyperthyroidism
22
Q
Sx thyroid storm (6)
A
Hyperpyrexia Severe tachyC Extreme restlessness Profuse sweating Confusion/psychosis Liver dysfunction
23
Q
Tx thyroid storm (5)
A
Propylthiouricale Propranolol K iodide High dose steroids Supportive measures
24
Q
Ix hyperthyroidism (5)
A
TSH Free T3/4 TRAb Technetium uptake scan CT/MRI orbit
25
Technetium uptake scan pattern - graves
diffuse pattern
26
Technetium uptake scan pattern - Toxic nodular goitre
One or more 'hot' nodules
27
Technetium uptake scan pattern - thyroiditis
Reduced/absent uptake
28
Mx hyperthyroidism - 1' care:
20-40mg propranolol tds
| Consider starting carbimazole if not controlled
29
What are the 2 types of antithyroid therapy for hyperthyroidism
Titration
| Block and replace
30
Titration regime antithyroid drugs
Start at high dose
| Titrate down until patient is euthyroid
31
block and replace titration regime
high dose
| Then levothyroxine added back once T3/4 levels controlled
32
1st line antthyroid drug
Carbimazole
33
2nd line antithyroid drug
Propylthyrouracil
34
Why is PTU 2nd line antithyroid drug
B/c risk severe liver injury 1/10,000
35
How do both antithyroid drugs work
Preffered substrate for TPO
36
Risk carbimazole (3)
Skin rashes
Agranulocytosis
Cholestatic jaundice
37
If a patient is on carbimazole, when should you advise them to see the GP?
If the develop any mouth ulcers, sore throats or fever
38
What is 1st line Tx hyperthryoidism in non-graves pt
Radioactive iodine therapy
39
How does radioactive iodine therapy work?
131I = taken up by thyroid cells
| --> Induces DNA damage + cell death
40
What must be done 1 week before starting radioiodine therapy?
Discontinue anti-thyroid drugs
41
C/I Radio active iodine (3)
Pregnancy
Brest feeding
Active Grave's ophthalmology
42
What should patients avoid after radio active iodine/
Avoid contact w/ children 3 w
| Do not try to concieve 6 months
43
what is the small increase risk of in patients who have radio active iodine therapy?
Thyroid cancer
44
Types of surgical Mx hyperthyroidism (2)
Total
| or sub-total thyroidectomy
45
Post-op complications thyroidectomy (4)
Haematoma --> asphyxia
Hypothyroidism
Hypocalcaemia
VC paresis b/c dmaage to rec laryngeal nn
46
Mx haematoma post thyroidectomy
ER removal of sutures
47
Prevelance hypothyroidism
1-2%
48
F:M hypothyroidism
10:1
49
common causes hypothyroidism (3)
Hashimoto's thyroiditis
Atrophic thyroiditis (autoimmune)
Prev Tx for hyperthyroidism
50
What is Hashimoto's thyroiditis
T cell destruction of gland
| + B cell secretion of inhibitory TSH receptor ab
51
Appearance goitre Hashimoto's thyroiditis
Symmetrical, bosselated goitre
52
Appearance goitre atrophic thyroiditis
NOT associated with goitre ;)
53
Less common causes hypothyroidism (5)
```
Drugs
Iodine deficiency
Thyroiditis
2' causes e.g.:
Hypothalamic disorders
Pituitary disorders
```
54
Drugs causing hypothyroidism (3)
Amiodarone
Iodine XS
Lithium
55
Sx hypothyroidism (7)
```
Tiredess
W gain
Cold intolerance
Goitre
Depression
Myalgia
Constipation
```
56
Signs hypothyroidism
```
Mental slowness
Dry thin hair
Dry skin
Slow relaxing reflexes
bradycardia
myxoedema
```
57
What is myxoedema
The accumulation of mucopolysaccarides in SC tissue
58
Ix hypothyroidism
```
FBC
TFTs
TPO antibodies
Cholesterol
CK
```
59
Why do we check Cholesterol + CK when investigation for hypothyroidism
Cholesterol -raised in hepatic hypothyroidism
| CK - raised in mm hypothyroidism
60
TFT values hypothyroidism (1' vs 2')
1' raised TSH, reduced T4
| 2' - low TSH + T4
61
Mx hypothyroidism
Levothyroxine for life
Low starting dose
reassess ev 4-6w until TSH in lower 1/2 norm
62
What does acute thyroiditis follow
URTI
63
PS acute thyroiditis (4)
Fever
Malaise
Thyroid swelling + tenderness
64
Appearance acute thyroiditis Tc scan
Low/no take up
65
Tx acute thyroiditis
propranolol + simple analgesia
66
Most common type of thyroid cancer
Papillary carcinoma
67
Who gets: papillary carcinoma
40-50y/o
68
Spread: papillary carcinoma
Local mostly
| Rarely --> lung/bone
69
Prognosis: papillary carcinoma
Good
70
RF papillary carcinoma
Previous neck irradiation
71
Tx papillary carcinoma
Surgical resection
72
Freq - follicular carcinoma
20%
73
Which sex gets more follicular carcinoma
Females
74
Spread: follicular carcinoma
Blood --> bone
75
Prognosis follicular carcinoma
Good if resectable
76
Tx follicular carcinoma
Surgical resection
77
% medullary cell carcinoma
5%
78
Who gets medullary cell carcinoma
Familial
Edlerly or
Children w/ MEN IIa/IIb
79
What cells do medullary cell carcinomas arise from
Parafollicular C cells
80
Spread medullary cell carcinoma
Local nodes + mets
| Slow growing
81
Prognosis medullary cell carcinoma
Poor
82
% anaplastic cell carcioma
<5%
83
Who gets anaplastic cell carcinoma
Elderly
84
Spread anaplastic cell carcinoma
Rapid, aggressive
| Locally invasive --> tracheal/SVC obstruction
85
Prognosis anaplastic cell carcinoma
Poor
86
Mx anaplastic cell carcinoma
External radiotherapy as palliation
87
PS thyroid cancer
Mostly asymp
May be hoarseness/dysphagia
usually euthyroid
