Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endocrinology > Hyperthyroidism, Hypothyroidism and Thyroiditis > Flashcards

Hyperthyroidism, Hypothyroidism and Thyroiditis Flashcards

1
Q

what causes secondary thyroid disease

A

hypothalamic or pituitary disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is thyrotropin

A

thyroid stimulating hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what makes up 80% of TSH

A

T4- biologically inactive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what plasma proteins does TSH bind to

A

TBG, albumin, pre albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is TSH released in response to

A

TRH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what happens to TSH when you are hypothyroid

A

is increased in attempt to get euthyriod

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is diodination

A

removal of iodine - T4 into T3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are hormone levels like in primary hypothyroidism

A

free T3/4 low

TSH high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are hormone levels like in primary hyperthyroidism

A 
free T3/4 high
TSH low (often 0)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are hormone levels like in secondary hypothyroidism

A

free T3/4 low

TSH low/ normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are hormone levels like in secondary hyperthyroidism

A

free T3/4 high

TSH high/ normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is myxoedema

A

either
coma-severe hypothyroidism, a medical emergency

or
swelling of the skin and underlying tissues giving a waxy consistency, typical of patients with underactive thyroid glands.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is pretibial myxoedema

A

sign of graves disease (hyperthyroidism) - infiltrative dermopathy resulting in localised lesions of the skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what ethnicity is hypothyroidism most common in

A

white populations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the causes of primary goitrous hypothyroidism

A

chronic thyroiditis (hashimotos), iodine deficiency, drug induced (amiodarone, lithium), maternally transmitted (antithyroid drugs e.g. for graves), hereditary biosynthetic defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the causes of primary non- goitrous hypothyroidism

A

atrophic thyroiditis (untreated hashimotos), post ablative therapy (radioiodine, surgery), post-radiotherapy (lymphoma treatment), congenital developmental defect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the causes of primary self limiting hypothyroidism

A

withdrawal of antithyroid drugs, subacute thyroiditis with transient hypothyroidism, post partum thyroiditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is hashimotos disease

A

autoimmune hypothyroidism - autoimmune destruction of thyroid gland and reduced thyroid hormone production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what characterised hashimotos (antibodies and histologically)

A

antibodies against thyroid peroxidase (TPO)

T cell infiltrate and inflammation microscopically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are the clinical features of hypothyroidism in the hair and skin

A

coarse sparse hair,
dull expressionless face,
periorbital puffiness,
pale cool skin that feels doughy to touch,
vitiligo may be present (another autoimmune disease),
hypercarotenaemia (yellowing of the skin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are the clinical features of hypothyroidism in thermogenesis

A

cold intolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are the clinical features of hypothyroidism in fluid balance

A

fluid retention- pitting oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are the cardiac clinical features of hypothyroidism

A

reduced heart rate, cardiac dilatation, pericardial effusion, worsening of heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the metabolic clinical features of hypothyroidism

A

hyperlipidaemia, decreased appetite, weight gain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are the GI clinical features of hypothyroidism

A

constipation, (megacolon, intestinal obstruction, ascites)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what are the respiratory clinical features of hypothyroidism

A

deep hoarse voice, macoglossia, obstructive sleep apnoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what are the neurological clinical features of hypothyroidism

A 
decreased intellectual and motor activities,
depression, psychosis, neuro-psychiatric,
muscle stiffness, cramps,
peripheral neuropathy, 
prolongation of tendon jerks,
carpal tunnel,
cerebellar ataxia, encephalopathy,
decreased visual acuity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what are the gynae/ reproductive clinical features of hypothyroidism

A

menorrhagia, later oligo- or amenorrhoea, hyperprolactinaemia (increased TRH causes increased PRL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what other lab abnormalities are seen in primary hypothyroidism

A

increased MCV
increased CK
increased LDL cholesterol
hyponatraemia (decreased tubular water loss)
hyperprolactinaemia (increased TRH and increased PRL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what antibodies for graves

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what antibodies for autoimmune hypothyroidism

A

anti TPO (95%)
anti-thyroglobulin (60%)
TSH receptor antibody (10-20%) (blocking)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what might rapid restoration of metabolic rate from hypothyroidism precipitate

A

cardiac arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is the management for hypothryoidism

A

slowly restore metabolic rate
Younger patients: start levothyroxine at 50-100 μg daily

In the elderly with a history of IHD: start levothyroxine at 25-50 μg daily, adjusted every 4 weeks according to response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

when should you check TSH when managing hypothyroidism

A

2 months after changing dose

if stable every 12-18 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

how do you manage secondary hypothyroidism

A

titrate dose of levothyroxine to the fT4 level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what is levothyroxine

A

T4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

when should levothyroxine be taken

A

preferable before breakfast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what can require the levothyroxine dose to be increased

A

pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

who usually gets myxoedema coma

A

elderly women with longstanding hypothyroidism that is frequently unrecognised or untreated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what is seen on ECG in myxoedema coma

A

bradycardia, low voltage complexes, varying degree heart block, T wave inversion, prolongation of the QT interval

41
Q

what are the resp signs of myxoedema coma

A

Type 2 respiratory failure: hypoxia, hypercarbia, respiratory acidosis

42
Q

how do you treat myxoedema coma

A 
ABC
passively warm to raise body temp 
cardiac monitoring for arrhythmias 
monitor: urine output, fluid balance, central venous system pressure, blood sugars, oxygenation 
broad spectrum antibiotics 
thyroxine cautiosly
43
Q

what precipitates myxoedema coma

A

when the body compensatory mechanism to hypothyroidism are overwhelmed by e.g an infection

44
Q

what is thyrotoxicosis

A

when tissues are exposed to excess thyroid hormone

45
Q

what is hyperthyroidism

A

conditions in which overactivity of the thyroid gland leads to thyroidtoxicosis

46
Q

what are the cardiac symptoms of thyrotoxicosis

A

palpation, AF, cardiac failure (rare)

47
Q

what are the sympathetic symptoms of thyrotoxicosis

A

tremor, sweating

48
Q

what are the CNS symptoms of thyrotoxicosis

A

anxiety, nervousness, irritability, sleep disturbance

49
Q

what are the GI symptoms of thyrotoxicosis

A

frequent loos bowel movements

50
Q

what are the vision symptoms of thyrotoxicosis

A

lid retraction, double vision (diplopia), proptosis (graves)

51
Q

what are the hair and skin symptoms of thyrotoxicosis

A

hair change (brittle, thin hair), rapid fingernail growth

52
Q

what are the reproductive symptoms of thyrotoxicosis

A

menstrual cycle changes, lighter bleeding and less frequent periods

53
Q

what are the muscular symptoms of thyrotoxicosis

A

muscle weakness- esp in upper arms and thighs

54
Q

what are the metabolic symptoms of thyrotoxicosis

A

weight loss despite increased appetite

55
Q

what are the thermogenesis symptoms of thyrotoxicosis

A

intolerance to heat

56
Q

what can cause excessive thryoid stimulation

A

graves disease, hashitoxicosis, thyrotropinoma (TSHoma rare), thyroid cancer (rarely causes thyrotoxicosis), choriocarcinoma (trophoblast tumour secreting hCG (similar to TSH))

57
Q

what are the types of thyroid nodules with autonomous function

A

toxic solitary nodule, toxic multinodular goitre

58
Q

what are the cases of thyrotoxicosis associated with hyperthyroidism

A

excessive thyroid stimulation and thyroid nodules with autonomous function

59
Q

what are the cases of thyrotoxicosis not associated with hyperthyroidism

A

thyroiditis, exogenous thyroid hormones, ectopic thyroid tissue

60
Q

what can cause thyroid inflammation (thyroiditis)

A

subacute (de Quervain’s) thyroiditis (self limiting viral condition),
post partum thyroiditis (self limiting),
drug induced (amiodarone (contains iodine))

61
Q

what can cause exogenous thryoid hormones to cause thyrotoxicosis

A

over treatment with levothyroxine,

thyrotoxicosis factitia

62
Q

what can lead to the production of ectopic thyroid tissue causing thyrotoxicosis

A 
metastatic thyroid carcinoma,
struma ovarii (teratoma containing thyroid tissue)
63
Q

who gets graves

A

slightly more common in women,

20-50 years

64
Q

what are the risk factors for graves

A

genes (70%) + environment
sister and children of women with graves
smoking important

65
Q

what other lab abnormalities are seen in graves

A

hypercalcaemia and increased alkaline phosphate (increased bone turnover- graves associated with osteoporosis),
leucopenia,
TSH receptor antibody

66
Q

what clinical signs are specific to graves

A

pretibial myxoedema, thyroid acropachy, thyroid bruit, graves eye disease (unilateral or bilateral)

67
Q

what causes a thyroid bruit

A

only large goitre in graves- reflects the hypervascularity of the thyoid
not heard in other goitrous conditiond

68
Q

what is graves eye disease associated with

A

smoking- really important to stop

69
Q

how is graves eye disease treated

A

mild- topically (e.g. lubricants)

more severe- steroids, radiotherapy, surgery

70
Q

is graves eye disease bad

A

can be sight threatening

71
Q

how many people with graves get graves eye disease

A

20%

72
Q

what is the onset for nodular thyroid disease

A

insidious onset

73
Q

who gets nodular thyroid disease

A

older patients

74
Q

what does nodular thyroid disease feel like

A

thyroid feels nodular, asymmetrical goitre (smooth in graves)

75
Q

what test results are seen in nodular thyroid disease

A

increased fT3/4, decreased TSH
antibody negative (TRAb),
scintigraphy high uptake,
thyoid ultrasound

76
Q

what is a thyroid storm

A 
medical emergency (ABC)
severe hyperthyroidism causing:
-respiratory and cardiac collapse 
-hyperthermia 
-exaggerated reflexes 
-(may require mechanical ventilation)
77
Q

who gets a thyroid storm

A

hyperthyroid patients with an acute illness/ infection or recent thyroid surgery

78
Q

what is the treatment for a thyroid storm

A

lugols iodine, glucocorticoids, PTU, beta blockers, fluids, monitoring

79
Q

what are the antithryoid drugs used to treat hyperthyroidism

A

carbimazole (1st line)

propylthiouracil (PTU) (first line in 1st trimester pregnancy)

80
Q

how to antithyroid drugs work

A

inhibits TPO (enzyme helps produce thyroid hormones)

81
Q

what are the side effects of anti thyroid drugs

A

well tolerated
1-5% rash, urticaria, arthralgia
cholestatic jaundice, increased liver enzymes, fulminant hepatic failure,
agranulocytosis (rare but warm patients for fever, oral ulcer or oropharyngeal infection)

82
Q

what is used for immediate symptomatic treatment for hyperthyroidism

A

beta blockers- propanalol (reduce activity of sympathetic nervous system)
CCB in those with asthma

83
Q

when is radioiodine used to treat hyperthyroidism

A

in relapsed graves disease and nodular thyroid disease

never in pregnancy

84
Q

when is a thyroiectomy used for hyperthyroidism

A

when radioiodine is CI

85
Q

what are the risks of a thyroidectomy

A

recurrent laryngeal nerve palsy, hypothyroidism, hypoparathyroidism

86
Q

what can cause thyroiditis

A 
Hashimoto’s
De Quervain’s/subacute (viral)
Post-partum
Drug-induced (amiodarone, lithium)
Radiation
Acute suppurative thyroiditis (bacterial)
87
Q

who gets subacute thyroiditis

A

females more than males, 20-50, can be triggered by viral infection

88
Q

what are the symptoms or subacute thyroiditis

A

neck tenderness, fever, viral symptoms, self limiting over a few months

89
Q

where in UK does hypothyroidism occur

A

in iodine rish areas

90
Q

where in UK does hyperthyroidism occur

A

in iodine deficient areas

91
Q

describe subclinical hypothyroidism

A 
increased TSH, normal fT3/4, risk of developing into overt hypothyroidism 
treatment advised (always in pregnancy)
92
Q

describe subclinical hyperthyroidism

A

decreased TSH, normal fT3/4, risk of developing into overt hyperthyroidism
treatment advised, associated with osteoporosis and AF, seen in multinodular goitres

93
Q

what is non thyroidal illness

A

when illness impacts the HPT axis- TSH typically suppressed initially then rises during recovery

94
Q 
68 yr old lady 
Tiredness
Weight gain
Slowness
Goitre

TSH 42 mU/L
Free T4 4 pmol/L

Normal Results:
TSH 0.4-4.0 mU/L
Free T4 9.8-18.8 pmol/L

A

Primary hypothyroidism

95
Q

68 yr old lady
Family history of thyroid disease
Tiredness
Goitre

TSH 12 mU/L
Free T4 11 pmol/L
TPO Antibodies 200 (elevated)

Normal Results:
TSH 0.4-4.0 mU/L
Free T4 9.8-18.8 pmol/L

A

Subclinical hypothyroidism

96
Q 
52 yr old male
Headache
Visual field defect
Dizziness/weakness
Poor libido/loss of erections
TSH 0.20 mU/L
Free T4 6 pmol/L

Normal Results:
TSH 0.4-4.0 mU/L
Free T4 9.8-18.8 pmol/L

A

Pituitary tumour causing secondary hypothyroidism

97
Q 
32 yr old lady 
Weight loss and tremor
Feels tired
Sleep disturbance
TSH <0.01 mU/L
Free T4 54 pmol/L

Normal Results:
TSH 0.4-4.0 mU/L
Free T4 9.8-18.8 pmol/L

A

Graves’ disease

98
Q 
70 yr old lady 
Diagnosed with atrial fibrillation
No symptoms
TSH <0.01 mU/L
Free T4  26 pmol/L

Normal Results:
TSH 0.4-4.0 mU/L
Free T4 9.8-18.8 pmol/L

A

Toxic multinodular goitre

99
Q 
32 yr old
Sore throat and febrile illness
Tired, weight loss, poor sleep
GP blood tests:
TSH<0.01, T4 36 pmol/L
Seen in clinic 6 weeks later
TSH 12 mU/L, Free T4 9 pmol/L

Normal Results:
TSH 0.4-4.0 mU/L
Free T4 9.8-18.8 pmol/L

A

Subacute thyroiditis

Endocrinology (46 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions