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2a- Endocrinology > Presentation and management of hypo/hyperthyroidism > Flashcards

Presentation and management of hypo/hyperthyroidism Flashcards

1
Q

What are the most common endocrine disorders?

A

Thyroid diseases

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2
Q

How many times greater are there females with thyroid disease than males?

A

5-10 fold

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3
Q

What are the prevalence of hyperthyroidism, hypothyroidism and goitre?

A
  • Hyperthyroidism 2.5% prevalence
  • Hypothyroidism 5%
  • Goitre 5-15%
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4
Q

What are examples of thyroid autoimmunity?

A
  • Focal thyroiditis and/or positive TPO and thyroglobulin antibodies
  • Postpartum thyroiditis
  • Autoimmune hypothyroidism
  • Graves’ disease
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5
Q

What are examples of autoimmune hypothyroidism?

A
  • Hashimoto’s thyroiditis
  • Atrophic thyroiditis
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6
Q

What happens in Graves’ disease?

A

Thyroid associated ophthalmopathy

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7
Q

What is found in almost all patients with autoimmune hypothyroidism?

A

Thyroglobulin and thyroid peroxidase (TPO) antibodies

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8
Q

Where are thyroglobulin and thyroid peroxidase (TPO) antibodies also found?

A
  • Also present in 75% Graves’ patients
  • Low levels present in healthy individuals at risk of thyroid or other autoimmune disease
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9
Q

What mediates the destruction of thyroid cells?

A

Cytotoxic (CD8+) T cell-mediated

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10
Q

What is goitre?

A
  • Palpable & visible thyroid enlargement
  • Variety of causes
  • Commonly sporadic or autoimmune
  • Endemic in iodine deficient areas
    • Thyroid tries to compensate and goes through hyperplastic change
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11
Q

Define hyperthyroidism

A

excess of thyroid hormones in blood

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12
Q

What are the 3 mechanisms for increased thyroid hormone?

A
  1. overproduction thyroid hormone
  2. leakage of preformed hormone from thyroid
  3. ingestion of excess thyroid hormone
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13
Q

What are causes of hyperthyroidism?

A
  • Common
    • Graves’ disease (75- 80% of all
      cases)
    • Toxic multinodular goitre
    • Toxic adenoma
    • Congenital hyperthyroidism
    • Thyroiditis
      (subacute/silent/postpartum)
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14
Q

Which drugs could cause hyperthyroidism?

A
  • Iodine
  • Amiodarone
  • Lithium?
  • Radiocontrast agents
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15
Q

What are clinical features of hyperthyroidism?

A
  • Wt loss
  • Tachycardia
  • Hyperphagia
  • Anxiety
  • Tremor
  • Heat intolerance
  • Sweating
  • Diarrhoea
  • Lid lag + stare
  • Menstrual disturbance
    • Heavy periods
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16
Q

What are the specific signs of Graves’?

A
  • Diffuse goitre
  • Thyroid eye disease (infiltrative)
  • Pretibial myxoedema
  • Acropachy
17
Q

What is a sign of MNG?

A

Multinodular goitre

18
Q

What is a sign of adenoma?

A

Solitary nodule

19
Q

What are the investigations for hyperthyroidism?

A
  1. Thyroid function tests to confirm biochemical hyperthyroidism
  2. Diagnosis of underlying cause important because treatment varies
  3. Clinical history, physical signs usually sufficient for diagnosis
  4. Supporting investigations
20
Q

What is most commonly on thyroid function tests for hyperthyroidism?

A

TSH supressed, T3, T4 elevated in primary hyperthyroidism
(In secondary hyperthyroidism ­high free T4, ­high free T3 but inappropriately high TSH)

21
Q

What is the treatment for hyperthyroidism?

A
  • Antithyroid drugs (course or long-term)
  • Radioiodine (131)I
  • Surgery (partial, subtotal thyroidectomy)
22
Q

Define hypothyroidism

A

Thyroid hormones levels abnormally low

23
Q

What are the 3 types of hypothyroidism?

A
  1. Primary (>99%)
    - absence / dysfunction thyroid gland
    - most cases due to Hashimoto’s thyroiditis
  2. Secondary/ tertiary
    pituitary / hypothalamic dysfunction
24
Q

What are causes of adult PRIMARY hypothyroidism?

A

● Hashimoto’s thyroiditis
● Thyroidectomy
● Iodine deficiency

25
Q

What are causes of adult SECONDARY/TERTIARY hypothyroidism?

A
  • Pituitary disease
  • Hypothalamic disease
26
Q

What are drugs that cause hypothyroidism?

A
  • Iodine
  • Lithium
  • Thionamides
27
Q

What are causes of child hypothyroidism?

A

● Neonatal hypothyroidism
● Resistance to thyroid hormone
● Isolated TSH deficiency

28
Q

What are clinical features of hypothyroidism?

A

● Weight gain
● Fatigue
● Dry, rough skin
● Menstrual disturbance
● Constipation
● Cold intolerance

29
Q

What would thyroid investigations of primary hypothyroidism show?

A

● Increased TSH usually decreased free T4, decreased T3
● T4/ T3 may be below normal in positive titre of TPO antibodies in Hashimoto’s

30
Q

What would thyroid investigations of secondary/tertiary hypothyroidism show?

A

TSH inappropriately low for reduced T4 / T3 levels

31
Q

What is the treatment for hypothyroidism in young adults?

A
  • usual full replacement of 100µg - titrate according to TSH
  • Requirements vary according to cause eg. higher doses in thyroid ablation
32
Q

How would you monitor treatment in hypothyroidism?

A
  • Dose titrated until TSH normalises
  • T4 half-life is long – check levels 6-8 weeks after dose adjustment
  • In secondary/ tertiary hypothyroidism TSH will always be low, T4 is monitored

2a- Endocrinology (17 decks)

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