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Hypo/hyperthyroidism Flashcards

(49 cards)

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1
Q

What is the difference between primary and secondary thyroid disease?

A

Primary - disease is of the thyroid gland

Secondary - disease is of the hypothalamus/pituitary

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2
Q

What tests can measure thyroid function?

A

TSH
Free T4/T3
T4/T3 bound to proteins

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3
Q

What three proteins can T3/T4 be bound to?

A

TBG, albumin & pre-albumin

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4
Q

Is the thyroid axis positive or negative feedback?

A

Negative

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5
Q

What are the lab results in hypothyroidism?

A

primary - low T3/T4, high TSH

secondary - low T3/T4, low TSH

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6
Q

What are the lab results in hyperthyroidism?

A

primary - high T3/T4, low TSH

secondary - high T3/T4, high TSH

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7
Q

Describe subclinical hypothyroidism

A

TSH high, T3/T4 normal

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8
Q

State the two main types of hypothyroidism

A

Goitrous & Non-goitrous

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9
Q

Name four causes of goitrous hypothyroidism

A
  • Hashimoto’s
  • Iodine deficiency
  • Drug induced
  • Maternal transmission
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10
Q

State two causes of non-goitrous hypothyroidism

A
  • Atrophic thyroiditis

- Iatrogenic

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11
Q

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

A

Hashimoto’s thyroiditis

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12
Q

Describe Hashimoto’s

A

TPO antibodies (thyroid peroxidase) cause T cell infiltrate & inflammation of the thyroid gland

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13
Q

What are the clinical features of hypothyroidism?

A
  • cold skin, puffy eyes, hypercarotenaemia
  • cold intolerance
  • pitting oedema
  • bradycardia
  • decreased appetite, increased weight
  • constipation
  • sleep apnoea
  • low mood
  • oligo/ammenorrhoea
  • hyperprolactinaemia
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14
Q

In hypothyroidism what will happen to sodium?

A

It will decrease

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15
Q

What is the treatment for hypothyroidism?

A

Levothyroxine (T4)

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16
Q

What is the medical emergency associated with hypothyroidism?

A

Myxoedema Coma

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17
Q

Describe the typical presentation of myxoedema coma

A

Older women with undiagnosed/untreated hypothyroidism - severe medical emergency (60% mortality)

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18
Q

What does myxoedema coma lead to?

A

Accumulation of mucopolysaccharides in the dermis & other tissues which attract water and cause swelling

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19
Q

How can myxoedema coma be managed?

A

ABCDE

  • identify & treat concurrent illness
  • passively rewarm
  • cardiac monitoring for arrhythmias
  • antibiotics
  • thyroxine & hydrocortisone
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20
Q

Define thyrotoxicosis

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A

clinical, physiological & biochemical state arising when tissues are exposed to excess thyroid

21
Q

Define hyperthyroidism

Study These Flashcards
A

conditions which overactivity of thyroid gland leads to thyrotoxicosis

22
Q

What are the clinical features of thyrotoxicosis?

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A
  • palpitations, AF
  • tremor, sweating
  • anxiety, nervousness, irritability
  • frequent, loose bowel movements
  • increased appetite, weight loss
  • proptosis. lid retraction
  • brittle, thin hair and skin
  • intolerance to heat
  • lighter, less frequent periods
  • muscle weakness
23
Q

State three things that can cause excess thyroid stimulation

Study These Flashcards
A
  • Graves Disease
  • Hashitoxicosis
  • Cancer
  • Thyroid Nodules
24
Q

State three causes of thyrotoxicosis not associated with thyroid disease

Study These Flashcards
A
  • Thyroid inflammation
  • Exogenous thyroid hormones
  • Ectopic thyroid tissue
25
What is the most common cause of hyperthyroidism in young people?
Grave's Disease
26
Describe Grave's Disease
TSH receptor antibodies (TRAb) act by stimulating thyroid hormone production
27
How does Grave's Disease arise?
susceptible genes + environmental factors
28
What lifestyle factor significantly increases risk of Grave's disease & treatment failure?
Smoking
29
What investigations should be carried out on a patient with suspected Grave's disease?
TSH, T3/T4 | Calcium, WCC, TRAb
30
Name four specific signs of Grave's disease
- pretibial myxoedema - thyroid acropachy - thyroid bruit - eye disease
31
What is the more common cause of hyperthyroidism in older patients?
Nodular disease - insidious onset asymmetrical goitre
32
Name the medical emergency associated with hyperthyroidism
Thyroid storm/crisis
33
How does thyroid storm present?
Severe systemic disease - respiratory/cardiac collapse & hyperthermia
34
How do you treat thyroid crisis?
Lugol's iodine/potassium iodide Glucocorticosteroids Beta blockers Fluids
35
What is first line treatment for hyperthyroidism?
Carbimazole
36
What is second line treatment for hyperthyroidism?
Propylthiouracil (inhibits DID1 to decrease conversion of T4 to T3 in the liver, less potent & may cause liver failure)
37
What is the potentially fatal side effect associated with drugs for hyperthyroidism?
Agranulocytosis - highest risk in first 6 weeks, in the event of the patient developing a fever the drug must be stopped immediately. Patient must be warned verbally & in writing
38
Name the beta blocker used in hyperthyroidism
Propanolol - useful for symptomatic relief
39
When is radio iodine used?
Relapsed Grave's, nodular thyroid disease
40
What is the key risk of radio-iodine?
Hypothyroidism
41
State the treatment used when radio-iodine is contraindiciated
Thyroidectomy - surgical & anaesthetic risks
42
What is thyroiditis?
Inflammation of thyroid
43
State the causes of thyroiditis
- virus/bacteria - hashimoto's - post partum - drugs/radiation
44
Describe the disease progression of subacute thyroiditis
Triggered by viral infection, associated with neck tenderness, fever or viral symptoms. Usually self-limiting
45
What is a normal thyroid level called?
euthyroid
46
How does amiodarone relate to thyroid?
Drug has a high concentration of iodine. Hypothyroidism can occur in iodine rich areas Hyperthyroidism tends to occur in iodine deficient areas
47
How does hypothyroidism arise due to amiodarone?
High iodine content may inhibit thyroglobulin iodination and thyroid synthesis & release causing hypothyroidism
48
How does hyperthyroidism arise due to amiodarone?
Iodine excess can increase hormone synthesis or alternatively (type 2) due to toxicity of amiodarone thyroiditis occurs
49
What happens to thyroid physiologically during illness?
TSH is suppressed initially but rises during recovery

Endocrine (17 decks)

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