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Endocrine > Hyperthyrodism, hypothyrodism and thyroditis > Flashcards

Hyperthyrodism, hypothyrodism and thyroditis Flashcards

1
Q

What can cause secondary thyroid disease?

A

Hypothalamic or pituitary disease

No thyroid gland pathology

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2
Q

When and where is TSH released?

A

Released by thyotroph cells in the anterior pituirary in response to thyrotropin releasing hormone (THR)

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3
Q

What percentage of thyroxine in T4 and T3?

A

80% T4

20% T3

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4
Q

What will the thyroid function tests look like in primary hypothyrodism?

A

Free T3/4 low

TSH high

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5
Q

What will the thyroid function tests look like in primary hyperthyrodism?

A

Free T3/4 high

TSH low - often falls to 0

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6
Q

What will the thyroid function tests look like in secondary hypothyrodism?

A

Free T3/4 low

TSH low

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7
Q

What will the thyroid function tests look like in secondary hyperthyrodism?

A

Free T3/4 high

TSH high

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8
Q

What is myoxedema?

A

Severe hypothyrodism

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9
Q

What is pretibial myxodeme?

A

Rare clinical sign of graves disease

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10
Q

What can cause goitrous hypothyrodism?

A 
Hashimoto's 
Iodine deficiency
Drug induced - amiodarone, lithium
Maternally transmitted - antithyroid drugs 
Heriditary biosynthetic defects
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11
Q

What can cause non-goitrous hypothyrodism?

A

Atrophic thyroditis
Post-ablative therpy (radioiodine, surgery)
Post-radiotherapy (lymphoma treatment)
Congenital developmental defect

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12
Q

What can cause self-limiting hypothyrodism?

A

Withdrawel of antithyroid drugs
Subacute thyrodidis
Post-partum thyroditis

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13
Q

What antibodies characterise hashimotos thyroditis?

A 
Thyroid peroxidate (TPO) 
T-cell infiltrate and inflammation microscopically
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14
Q

What are the hair and skin features associated with hypothyrodism?

A 
Coarse, sparse hair
Dull face
Periorbial puffiness
Pale skin
Vitiligo
Hypercarotenaemia
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15
Q

What are the thermogenesis features associated with hypothyrodism?

A

Cold intolerance

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16
Q

What fluid retention can occur with hypothyrodism?

A

Pitting oedema

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17
Q

What are the cardiac features associated with hypothyrodism?

A

Bradycardia
Dilation
Pericardial effusion
Worsening of heart failure

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18
Q

What are the metabolic features associated with hypothyrodism?

A

Hyperlipidaemia

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19
Q

What are the metabolic rate features associated with hypothyrodism?

A

Decreased appetite

Weight gain

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20
Q

What are the GI features associated with hypothyrodism?

A

Constipation

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21
Q

What are the resp features associated with hypothyrodism?

A

Deep hoarse voice
Macroglossia
Obstructive sleep apnoea

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22
Q

What are the neurological features associated with hypothyroidism?

A 
Decreased intellectual and motor activities 
Depression, psychosis
Muscle stiffness
Peripheral neuropathy 
Prolongation of tendon jerks 
Carpal tunnel syndrome
Reduced visual acuity
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23
Q

What gynae features associated with hypothyroidism?

A

Mennorhagia
Amenorrhoea
Hyperprolactinaemia

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24
Q

What are the lab features associated with hypothyroidism?

A

Increased TSH and redueced fT4/3
Increased LDL
Hyponatraemia
Hyperprolactinaemia

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25
What is the management of hypothyrodism?
Metabolic rate restored GRADUALLY as rapid restoration may precipitate cardiac arrhythmias Levothyroxine 50-100 micrograms
26
How should the management of hypothyrodism be monitored?
Check TSH 2 months after any dose change | Once stabilised, TSH should be checked every 12-18 months
27
When should levothyroxine be taken?
Before breakfast
28
What adjustments need to be made to levothyroxine in pregnancy?
Dose requirements may increase by 25-50% in pregnancy due to incresaed TBG
29
Who does myxoedema coma affect?
Typically affects elderly women with long standing but frequently unrecognized or untreated hypothyrodism
30
What are the common findigns in a myxoedema coma?
ECG: bradycardia, heart blocks, T wave inversion, prolonged QT Type 2 resp failure: hypoxia, hypercarbia, resp acidosis Co-exising adrenal failure
31
How is myxoedema coma treated?
``` ICU Passive rewarm Cardiac monitoring Monitor urine, fluid, CVP, surgars and oxygenation Broad spectrum antibiotics Thyroxine cautiousl ```
32
What is the difference between thyrotoxicosis and hyperthyroidism?
Thyrotoxicosis: clinical, physiological and biochemical state arising when tissues are exposed to excess thyroid Hyperthyroidism: refers specifically to conditions in which overactivity of the thyroid gland leads to thyrotoxicosis
33
What are the cardiac features of hyperthyroidism?
Tachycardia Palpitation AF Cardiac failure (v rare)
34
What are the sympathetic symptoms of hyperthyroidism?
Tremor | Sweating
35
What are the CNS features of hyperthyroidism?
Anxiety Nervousness Irritability Sleep disturbance
36
What are the GI features of hyperthyroidism?
Diarrhoea
37
What are the vision features of hyperthyroidism?
Lid retraction Double vision (diplopia) Proptosis (graves)
38
What are the hair and skin features of hyperthyroidism?
Brittle and thin hair | Rapid fingernail growth
39
What are the reproductive features of hyperthyroidism?
Menstrual cycle changes - lighter bleeding and less frequent
40
What are the metabolism features of hyperthyroidism?
Weight loss despite increased appetite
41
What are the thermogenesis features of hyperthyroidism?
Heat intolerance
42
What thyrotoxicosis causes are associated with hyperthyroidism?
``` Graves Thyroid nodules Hashitoxicosis Thyrotropinoma Thyroid cancer Choriocarcinoma ```
43
What thyrotoxicosis causes are not associated with hyperthyroidism?
``` Thyroid inflammation: Subacute (de Quervain's) thyroiditis Postpartum thyroiditis Drug-induced thyroiditis Exogenous thyroid hormones: over-treatment with levothyroxine Thyrotoxicosis factitia Ectopic thyroid tissue: Metastatic thyroid carcinoma Struma ovarii ```
44
What are the lab investigations of graves disease?
Decreased TSH and increased fT4/3 Hypercalcaemia Increased alk phos
45
What antibody is commonly present in graves?
TSH receptor antibody | Anti-TPO
46
What clinical signs are specific to graves?
Pretibial myxoedema Thyroid acropachy Thyroid bruit TED/ Graves opthamology
47
How is graves opthamology treated?
Mild: topical Severe: steroids, radiotherapy, surgery
48
Who is likely to get nodular thyroid disease?
Older patients
49
What will nodular thyroid disease have biochemically?
``` Increased fT4/3 Decreased TSH Antibody negative Scintigraphy: high uptake Thyroid US ```
50
What is a thyroid storm?
Severe hyperthyroidism
51
What are the signs and symptoms of a thyroid storm?
Resp and cardiac collapse Hyperthermia Exaggerated reflexes
52
How is a thyroid storm treated?
``` Lugol's iodine Glucocorticoids PTU Beta blockers Fluids Monitoring ```
53
How does carbimazole work?
Inhibits TPO therefore blocking thyroid hormone synthesis
54
What is the first line drug in hyperthyroidism?
Carbimazole
55
What is the first line drug for hyperthyroidism in the 1st semester of pregnancy?
Propylthiouracil
56
How is graves treated?
Dose titrate for a year OR High dose for 6 months then treat with levothyroxine
57
What are the side effects of anti-thyroid drugs?
Allergic type - rash, urticaria, arthralgia Cholestatic jaundice, deranged LFTs, fulminant hepatic failure Agranulocytosis
58
What is agranulocytosis?
Bone marrow switches off the production of neutrophils
59
What is the advice given for a patient starting on ATDs?
Stop drug and have urgent FBC in event of fever, oral ulcer or oropharyngeal infection esp within first 6 weeks
60
When are beta blockers used in hyperthyroidism?
Immediate symptomatic relief of thyrotoxic symptoms
61
What beta blocker is used in hyperthyroidism?
Propranolol | Additionally inhibits DIO1
62
In what patients are beta blockers CI?
Asthma - use CCB (diltiazem) instead
63
When is radioiodine used in hyperthyroidism?
1st choice treatment for relapsed graves' disease and nodular thyroid disease
64
Can radioiodine be used in pregnancy?
No
65
Can radioiodine be used in active thyroid eye disease?
Preferably no
66
When is a thyroidectomy utilised?
When radioiodine is CI or fails to work
67
What conditions fall under thyroiditis?
``` Hashimoto's De Quervain's (viral) Postpartum Drug induced (amiodarone, lithium) Radiation Acute suppurative thyroiditis ```
68
What are the associated symptoms with subacute thyroiditis?
Neck tenderness, fever or other viral symptoms
69
What is sick euthyroid syndrome?
Encountered in the unwell, hospitalised patient | Intercurrent infection has an impact on the HPT axis and TSH is typically suppressed and then rises during recovery

Endocrine (35 decks)

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