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hyperthyroidism, hypothyroidism and thyroiditis Flashcards

1
Q

what does primary thyroid disease mean?

A

-a disease affecting the thyroid gland itself

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2
Q

what are the levels of T4, T3 and TSH like in primary hypothyroidism?

A 
T4/T3= too low
TSH= high
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3
Q

what are T3, T4 and TSH levels like in primary hyperthyroidism?

A

T3 + T4= high

TSH= low

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4
Q

what are T3, T4 and TSH like in secondary hypothyroidism?

A

T3 + T4= low

TSH= low (or ‘normal’)

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5
Q

what are T3, T4 and TSH like in secondary hyperthyroidism?

A

T3 + T4= high

TSH= high (or normal)

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6
Q

what is myxoedema?

A

-severe hypothyroidism and is a medical emergency

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7
Q

what is pretibial myxoedema?

A

a rare clinical sign of Graves’ disease (an autoimmune disease which results in hyperthyroidism)

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8
Q

who is hypothyroidism more common in?

A
  • women
  • white population
  • incidence is higher in areas of high iodine intake
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9
Q

what is the most common cause of hypothyroidism in western world?

A

autoimmune (hashimotos)

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10
Q

what increases risk of getting hashimotos?

A

-family history of autoimmune or thyroditis

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11
Q

what most common antibodies found in Hashimoto’s?

A

thyroid peroxidase antibodies

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12
Q

what can occur to hair and skin in hypothyroidism?

A
  • coarse, sparse hair
  • dull, expressionless face
  • periorbital puffiness
  • pale cool skin that feels doughy to touch
  • vitiligo may be present
  • hypercarotenaemia
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13
Q

how may a patients tolerence to temperature change if they have hypothyroidism?

A

-they may develop cold intolerance

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14
Q

what are some cardiac clinical features of hypothyroidism?

A
  • reduced heart rate
  • cardiac dilatation
  • pericardial effusion
  • worsening of heart failure
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15
Q

what affect does hypothyroidism have on lipidaemia?

A

it can cause hyperlipidaemia

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16
Q

what affect does hypothyroidism have on appetite and weight?

A
  • decreased appetite

- increased weight gain

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17
Q

what are some GI clinical features of hypothyroidism?

A
  • constipation
  • megacolon and intestinal obstruction
  • ascites
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18
Q

what are some resp clinical features of hypothyroidism?

A
  • deep hoarse voice
  • macroglossia
  • obstructive sleep apnoea
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19
Q

what are some neurological/CND clinical features of hypothyroidism?

A
  • decreased intellectual and motor activities
  • depression, psychosis and neuro psychiatric
  • muscle stiffness, cramps
  • peripheral neuropathy
  • prolongation of the tendon jerks
  • carpal tunnel syndrome
  • decreased visial acuity
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20
Q

what are some gynae/reproductive clinical features of hypothyroidism?

A
  • menorhagia
  • later oligo or amenorrhoea
  • hyperprolactaemia
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21
Q

what causes hyperprolactaemia?

A

high TRH (once TRH is lowered it can be reversed)

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22
Q

what is treatment for hypothyroidism in younger patients?

A

-start levothyroxine (T4) at 50-100 micrograms daily

check TSH 2 months after any dose change and once stabilised check TSH every 12-18 months

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23
Q

what is treatment for hypothyroidism in older patients?

A

in elderly patients with a history of IHD:
-start levothyroxine (T4) at 25 to 50 micrograms daily, adjust every 4 weeks according to response

-TSH should be checked 2 months after any dose change and once stabilised TSH should be checked every 12-18 months

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24
Q

when should levothyroxine (T4) be taken?

A
  • before breakfast (on empty stomach)

- doesn’t work if taken with PPI, iron tablets and calcium tablets as they impair the absorption

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25
what should happen to dose of levothyroxine to a pregnant patient with hypothyroidism?
dose of levothyroxine should be increased by 25-50%
26
who does myxoedema coma usually affect?
-elderly women with long standing but frequently unrecognized or untreated hypothyroidism
27
what are the signs of a myxoedema coma?
ECG: bradycardia, low voltage complexes, varying degrees of heart block, T wave inversion, prolongation of the QT interval Type 2 respiratory failure: hypoxia, hypercarbia, respiratory acidosis In 10% of patients there is co existing adrenal failure
28
what is the treatment for myxoedema coma?
- ICU - passive rewarm (aim for slow rise in body temp) - cardiac monitoring for arrhythmias - close monitoring of urine output. fluid balance, central venous pressure, blood sugars, oxygenation - broad spectrum antibiotics - thyroxine cautiously (hydrocortisone)
29
what is thyrotoxicosis?
-a clinical, physiological and biochemical state arising when tissues are exposed to excess thyroid hormone
30
what are cardiac signs/symptoms in thyrotoxicosis?
- palpitations - AF - cardiac failure (very rare) - tremor - sweating
31
what are CNS signs/symptoms in thyrotoxicosis?
- anxiety - nervousness - irritability - sleep disturbances
32
what are GI signs/symptoms in thyrotoxicosis?
-frequent, loose bowel movements
33
what are vision signs/symptoms in thyrotoxicosis?
- lid retraction - double vision - proptosis
34
what are hair and skin signs/symptoms in thyrotoxicosis?
brittle, thing hair | rapid fingernail growth
35
what are reproductive signs/symptoms in thyrotoxicosis?
-menstrual cycle changes (including lighter bleed and less frequent periods)
36
what are the changes in muscles in thyrotoxicosis?
-muscle weakness (especially in thigha and upper arms)
37
what are the changes in weight in someone with thyrotoxicosis?
weight loss even though there's increased apetite
38
what is a patients with thyrotoxicosis tolerance to temperature like?
-they have an intolerance to heat
39
who does Grave's disease usually affect?
younger 20-50 years
40
what are some clinical signs/features of Grave's?
- pretibial myxoedema - thyroid acropachy - thyroid bruit - Grave's eye disease
41
who does nodular thyroid disease typically affect?
-older patients
42
what tests are done if a patient has suspected nodular thyroid disease?
- increase T4/3 - decrease TSH - antibody negative (TRAb) - thyroid US - scintigraphy: high uptake
43
what is the first line treatment for hyperthyroidism?
1st line= Carbimazole once daily
44
what is the first line treatment for someone in their first trimester of pregnancy?
Propylthiouracil (PTU) twice daily
45
side effects of using carbimazole in pregnancy?
-risk of aplasia cutis in early pregnancy
46
side effects of propylthiouracil (PTU)
1:10,000 risk of liver failure
47
what type of drug is carbimazole?
ATD (antithyroid drug)
48
what are side effects of ATDs (carbimazole)?
- 1 to 5% will develop allergic reaction (rash, urticaria, arthralgia) - cholestatic jaundice, increase liver enzymes, fulminant hepatic failure (PTU) - agranuloytosis
49
what is agranulocytosis?
-a life-threatening blood disorder when the body cannot make enough of a type of white blood cell called neutrophils
50
what should the patient be warned about and how before starting carbimazole?
- warned about the side effect of agranulocytosis - warn patient verbally and in writing to stop drug and have urgent FBC checked in event of fever, oral ulcer or oropharyngeal infection
51
when should a patient get an urgent FBC and stop taking carbimazole?
in event of : - fever - oral ulcer - oropharyngeal infection
52
when is risk of getting agranulocytosis highest when on carbimazole?
-in first 6 weeks
53
what treatment is good for immediate symptomatic relief of thyrotoxic symptoms in patients with hyperthyroidism?
BB (propanolol)
54
what is 1st line treatment of relapsed Graves' disease ?
radioiodine
55
what is 1st line treatment of nodular thyroid diseases?
radioiodine
56
when is radioiodine contraindicated?
- in pregnancy | - relatively in active thyroid eye disease
57
what is a high risk when treating Grave's patients with radioiodine?
-high risk of hypothyroidism
58
when is a thyroidectomy the choice of treatment in hyperthyroidism?
-when radioiodine is contraindicated
59
what risks does a thyroidectomy bring?
- recurrent laryngeal nerve palsy - hypothyroidism - hypoparathyroidism
60
what is thyroiditis?
inflammation of the thyroid
61
who is subacute thyroiditis typically found in?
-females ages 20-55
62
what may trigger subacutre thyroitisis?
-viral infection
63
what are some associated symptoms of subacute thyroiditis?
- neck tenderness - fever - and/or other viral symptoms
64
what are the investigations for subacute thyroiditis?
scintigraphy scan (low uptake throughout)
65
what are some causes of thyroiditis?
- hashimotos - de quervain's/subacute - post partum - drug induced (amiodarone, lithium) - radiation - acute suppurative thyroiditis (bacterial)
66
what is the treatment for subacute thyroiditis?
-its usually self limiting (few months)
67
what is subclinical al thyroid disease?
-abnormal TSH with normal thyroid hormone levels
68
what would T3, T4 and TSH be like in subclinical hypothyroidism?
``` TSH= increase T4/T4= the same ```
69
what would T3, T4 and TSH be like in subclinical hyperthyroidism?
``` TSH= lower T3/T4= the same ```
70
when is treatment advised in subclinical hypothyroidism?
- when TSH>10 | - if pregnancy
71
when is treatment advised in subclinical hyperthyroidism?
- when TSH<0.1 | - or if there's coexisting osteoporosis/fracture or AF
72
what increases risk of getting sunclinical hypothyroidism?
-if TPO antibody positve
73
what increases risk of getting sunclinical hyperthyroidism?
- multinodular goitre | - if patient has Afib or osteoporosis
74
what is non thyroidal illness also known as?
sick euthyroid syndrome
75
who is non thyroidal illness commonly seen in?
-unwell, hospitalised patients
76
what are TSH levels like in non thyroidal illness ?
TSH typically supressed initially and then rises during recovery
77
who os postpartum thyroiditis more common in?
-type 1 diabetic women
78
how does postpartum thyroiditis present?
- temporary overactive thyroid and after a few weeks becomes under active - occurs after birth - however not all women with postpartum thyroiditis will go through both phases
79
what is De Queverain's thyroiditis?
-thyroiditis caused by a viral infection such as mumps or flu
80
how does De Queverain's thyroiditis present?
- initially hyperthyroidism and then after a couple weeks can become hypo - this can resolve spontaneously or hypothyroidism may become permenant - fever - pain in neck, jaw or ear

Endocrine (53 decks)

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