Hyper/hypothyroidism Flashcards Preview

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Flashcards in Hyper/hypothyroidism Deck (37):
1

What is the commonest cause of hypo or hyperthyroidism

Autoimmne thyroid disease

2

What is meant by primary thyroidism

The problem is with the gland itself

3

What is meant by secondary thyroidism

The problem is with the hypothalamus or pituitary

4

What do we need to measure when measuring thyroid hormone

TSH
T4 and T3 (both free)

5

What would the thyroid hormones be like in hyperthyroidism

High level of T4 and T3 and low TSH

6

What would the thyroid hormones be like in hyperthyroidism

High TSH and low T3,T4

7

What is meant by primary subclinical hypothyroidism

on the way to developing primary hypothyroidism but have not quite got there yet but the pituitary is having to work harder to maintain normal levels

8

In what kind of hypothyroidism is TSH normal

Secondary

9

In what kind of hypothyroidism is fT4 normal

Subclinical hypothyroidism

10

What is the name given to the skin on the shins in Grave's disease

Pretibial myxoedema

11

In what population is the incidence higher for hypothyroidism

Hispanics or African-American populations or in those with a high iodine intake

12

What are the 3 main categories for causes of primary hypothyroidism

Goitrous
Non-goitrous
Self-limiting

13

What are the 2 main goitrous causes of primary hypothyroidism

chronic thyoiditis or iodine deficiency

14

What is Hashimoto's thyroiditis

The most common cause of hypothyroidism in Western world - autoimmune destruction of thyroid gland resulting in reduced thyroid hormone production

15

What is Hashimoto's thyroiditis characterised by

Presence of thyroid peroxidase antibodies
T cell infiltrate and inflammation on microscopy

16

What are some signs and symptoms of hypothyroidism

Coarse, sparse hair
Dull expresiionaless face
puffiness around the eyes
pale, cool skin
doughy touch to skin
vitiligo
hypercarotenaemia
cold intolerance
constipation
reduced heart rate
cardiac dilatation
pericardial effusion
hyperlipidaemia
decreased appetite
weight gain
ascites
deep hoarse voice
macroglossia
obstructive sleep apnoea
preipheral neuropathy
muscle stiffness
prolonged reactions
depression, psychosis
mental sluggishness
Menorrhagia hyperprolactinaemia

17

What antibody is the most sensitive in Grave's disease

anti-TPO antibody

18

What is the management for hypothyroidism in young

start thyroxine at 50-100ug daily

19

What is the management for hypothyroidism in older

thyroxine 25-50ug adjust every 4 weeks according to response

20

When should TSH be checked after treatment has commenced

2 months after any dose change then when stable, every 12-18 months

21

What should the dose of thyroxine be increased by in pregnancy

25ug

22

Who is typically affected by a myxoedema coma

Elderly women with long standing but frequently unrecognised or untreated hypothyroidism

23

How is a myxoedema coma treated

Intensive care
passively rewarm
cardiac monitoring for arrhythmias
monitor BP,CVP, O2, urine output, BMs
Fluids / electrolyte balance / fluid restriction

24

What are some signs and symptoms of hyperthyroidism

Palpatations/AF
cardiac failure
tremor
sweating
Anxiety
nervousness
irritability
sleep disturbance
loose bowel movements
increased bowel movements
lid retraction
double vision
brittle hair or thinning
rapid fingernail growth
menstrual changes
muscle weakness
weight loss
decreased appetite
intolerance to heat

25

What are some causes of hyperthyroidism

Auto-immune - Graves
Nodular - multi-nodular goitre or toxic nodule
Thyroiditis - subacute or postpartum
Iodine
Medication (lithium, amiodarone, thyroxine

26

Graves disease affects women more than men. True or false

True

27

What are some additional features in Grave's disease

Lid retraction
lid lag
chemosis
proptosis
visual loss
diplopia

28

What are the treatment options for opthalmopathy

Lubricants
decompression surgery
radiotherapy
corrective surgery
stop smoking

29

What may occur during a thyroid storm

Severe hyperthyroidism
respiratory and cardiac collapse
hyperthermia
exaggerated reflexes
ventilation
underling infection

30

What is the treatment for a thyroid storm

Lugols Iodine
Glucocorticoids
PTU
B blockers
fluids
monitoring

31

What is the treatment for hyperthyroidism

Carbimazole
Propylthiouracil

32

How do we treat Grave's

Start oral medication at a high dose and reduce over 12-18 months and stop

33

What is thyroiditis

Inflammation of the their gland

34

What are some examples of thyroiditis

Graves
Hashimotos
DeQuervains
Post partum
drug induced
Acute

35

Who is more likely to develop De Quervains

Females
20-50 years
may be associated with sore throat / fever/ other viral symptoms

36

Describe the fluctuation of T4 in De Quervains

High in early stage, low in late then normal

37

Describe the fluctuation of TSH in De Quervains

Low in early stage, high in late, then normal