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Thryoid Flashcards

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1
Q

what eye problems can occur with graves disease?

A 
 Exophthalmos
 Ophthalmoplegia: esp. up-gaze palsy
 Eye discomfort and grittiness
 Photophobia and ↓ acuity
 Chemosis
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2
Q

what skin problem can occur with graves disease?

A

pre-tibial myxoedema

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3
Q

what is thyroid acropachy?

A

presents with digital clubbing, swelling of digits and toes, and periosteal reaction of extremity bones

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4
Q

what disease can thyroid acropachy occur/

A

graves disease

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5
Q

what antibodies are present with thyrotoxicosis?

A

TSH receptor, TPO

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6
Q

state three conditions graves is associated with?

A

T1DM
Vitiligo
addisons

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7
Q

what scan can be done for thyrotoxicosis?

A

isotope scan

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8
Q

what can trigger graves disease?

A

stress infection child birth

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9
Q

what is plummers disease?

A

toxic multinodular goitre

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10
Q

what does the iodine scan show for plummers disease?

A

hot nodules

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11
Q

does toxic adenoma have hot or cold nodules?

A

hot nodules

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12
Q

what drugs can cause thyrotoxicosis ?

A

thyroxine

amiodarone

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13
Q

what medication can be given for thyrotoxicosis?

A

beta blockers

carbimazole

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14
Q

what is the action of carbimazole?

A

inhibits TPO

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15
Q

what is a SE of carbimazole?

A

agranulocytosis

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16
Q

what is a CI of radio iodine ?

A

pregnancy, lactation

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17
Q

what are three complications of thyroidectomy?

A

recurrent laryngeal nerve damage
hypoparathyroidism
hypothyroidism

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18
Q

what are features of a thyroid storm?

A 
 ↑ temp
 Agitation, confusion, coma
 Tachycardia, AF
 Acute abdomen
 Heart failure
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19
Q

what is the medication treatment for thyroid storm?

A
  1. Propranolol PO/IV
  2. Digoxin may be needed
  3. Carbimazole then Lugol’s Iodine 4h later to inhibit thyroid
  4. Hydrocortisone
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20
Q

what is myxoedema?

A

SC tissue swelling in severe hypothyroidism

 Typically around eyes and dorsum of hand

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21
Q

does myxoedema occur in hypo/hyperthroidism?

A

hypothyroidism

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22
Q

what is the commonest cause of hypothyroidism in the UK?

A

atrophic thyroiditis

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23
Q

what is the commonest cause of hypothyroidism in the world?

A

iodine deficiency

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24
Q

what medication can cause hypothyroidism?

A

carbimazole
amiodarone
lithium

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25
state some causes of hypothryoidism ?
Atrophic thyroiditis (commonest UK)  Hashimoto’s thyroiditis  Subacute thyroiditis (e.g. post-partum)  Post De Quervain’s thyroiditis  Iodine deficiency (commonest worldwide)  Drugs: carbimazole, amiodarone, lithium  Congenital: thyroid agenesis Post-surgical  Thyroidectomy  Radioiodine
26
what antibodies are present in atrophic thyroiditis?
anti-TPO, anti-TSH
27
what three conditions is atrophic thyroiditis associated with?
Pernicious anaemia Vitiligo Endocrinopathies
28
what antibody is + for hashimotos thyroiditis?
TPO +ve
29
what is the treatment for hypothyroidism?
levothyroxine
30
what is a myxoedema coma
``` Looks hypothyroid  Hypothermia  Hypoglycaemia  Heart failure: bradycardia and ↓BP  Coma and seizures ```
31
what is the management for myxoedema coma?
correct any hypoglycaemia T3/T4 IV slowly hydrocortisone 100mg IV
32
what is a common virus to cause de Quervains ?
coxsackie
33
what is the treatment for de Quervains?
self limiting
34
what are the different types of malignant thyroid disease called/
``` papillary follicular medullary anaplastic lymphoma ```
35
what is the most common thyroid cancer?
papillary
36
what are some complications of thyroid surgery?
``` haematoma laryngeal oedema recurrent layrngeal nerve palsy hypoparathyroidism thyroid storm ```
37
what recurrent laryngeal nerve is most common injuried?
Right because of oblique ascent
38
what happens when one and both laryngeal nerves are damaged ?
 Damage to one → hoarse voice |  Damage to both → obstruction needing trachyostomy
39
what happens to Ca after hypoparathryoidism?
low ca
40
what thyroid cancers have thyroglobulin tumour marker?
papillary | follicular
41
what tumour markers does medullary tumour have?
CEA and calcitonin markers
42
what cells are affected by papillary and follicular cancers?
follicular cells
43
where does papillary cancer spread?
lung and nodes | - JDG node (jugulodiagastric node = lateral aberrant thyroid)
44
what does lateral aberrant thyroid mean?
when thyroid tissue is found in a distant location than normal (due to spread of cancer)
45
what cells are the origin of medullary cancer?
parafollicular C cells
46
what is the treatment of thyroid cancer?
total thyroidectomy node excision radio iodine T4 to suppress TSH
47
what are the two clinical signs seen in hypocalcemia ?
Chvosteks and trousseaus
48
state some indications of thyroid surgery ?
Pressure symptoms 􏰀 Relapse hyperthyroidism (>1 failed drug Rx) 􏰀 Cosmesis 􏰀 Carcinoma
49
where is the incision for thyroid surgery?
collar incision
50
what is the commonest cause of primary hyperparathyroidism?
solitary adenoma
51
what investigations should be done for primary hyperparathyroidism ?
Ca, PTH, ALP, PO4 levels ECG Xray DEXA
52
what ECG changes would be seen in hypercalcaemia?
``` decreased QTc (bradycardia) - 1st degree heart block ```
53
what changes would be seen on Xray for hypercalcaemia ?
osteoitis fibrous cystica
54
what changes would be seen on DEXA scan for hypercalcaemia?
osteoporosis
55
apart from solitary adenoma what is another cause of hyperparathyroidism?
hyperplasia
56
what is the treatment for hyperparathyroidism ?
increase fluid intake avoid dietary Ca and thiazides excision of adenoma
57
what are some causes of secondary hyperparathyroidism ?
vitamin D deficiency | chronic renal failure
58
is phosphate increased or decreased with primary hyperparathyroidism ?
decreased | - decreased reabsorption at the kidney due to increased PTH
59
is phosphate increased or decreased with secondary hyperparathyroidism ?
increased
60
does primary hyperparathyroidism lead to hyper/hypocalcaemia?
hypercalcaemia | - more PTH to increase Ca
61
does secondary hyperparathyroidism lead to hyper/hypocalcaemia?
hypocalcaemia | - less Vit D
62
is ALP increased or decreased with hyperparathyroidism ?
increased
63
what is the treatment for secondary hyperparathyroidism ?
correct cause phosphate binders vitamin D cinacelcet (increases parathyroid Ca sensitivity)
64
what ECG changes can be seen on hypoparathyroidism? (hypocalcaemia)
increased QTc which can develop into TdP (Torsades de pointes)
65
what are three causes of hypoparathyroidism?
autoimmune DiGeorge Iatrogenic (surgery/radiation)
66
what are the features of DiGeorge syndrome?
``` Cardiac abnormality: Fallot’s 􏰁 Abnormal facies 􏰁 Thymic aplasia 􏰁 Cleft palate 􏰁 Hypocalcaemia 􏰁 Chr 22 ``` CATCH 22
67
is the level of ALP increased/decreased or normal with hypoparathyroidism?
normal
68
what is the treatment for hypoparathyroidism?
Ca supplements | calcitriol
69
what causes pseudohypoparathyroidism?
Failure of target organ response to PTH
70
what is a characteristic features of pseudohypoparathyroidism?
Short 4th and 5th metacarpals, short stature
71
what is the treatment for pseudohypoparathyroidism?
calcium | calcitriol
72
what is Pseudopseudohypoparathyroidism?
Normal (maternal) receptor in kidney → normal biochem Abnormal (paternal) receptors in body → pseudohypoparathyroidsm phenotype

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