Thyroid

Question 1

what does endocrinology include

Answer 1

Disorders of hormones and the glands

Question 2

What is the term steroids often used to describe

Answer 2

Anti-inflammatory and immunosuppressive drugs act via cortisol receptors

Question 3

What are the 3 basic things that can go wrong with an endocrine gland

Answer 3

1. Failure to produce its hormone
2. Excessive production of hormone
3. Swellings

Question 4

What is a common cause of endocrine gland failure

Answer 4

Destruction of the gland

Question 5

Give some examples of what may cause endocrine gland failure

Answer 5

1, Infection
2. Radiation
3. Invasion by tumours
4. Pituitary disease
5. Secondary to unregulated pituitary hormone secretion
6. Tumours

Question 6

Give examples of adrenal gland disorders

Answer 6

1. Cushing’s disease
2. Addison’s disease
3. Conn’ syndrome

Question 7

What is Cushing’s disease caused by

Answer 7

An excess glucocorticoid production secondary to adrenal hyperplasia.

Question 8

What effect does systemic steroid treatment suppress

Answer 8

Normal pituitary adrenal axis resultan in atrophy of the norm cortisol secretion adrenal cells

Question 9

What can cortisol cause

Answer 9

Resistance to insulin resulting in impaired glucose tolerance or diabetes

Question 10

What test should we do to assess and diagnose non iatrogenic bushings disease

Answer 10

measurement of the plasma or urine cortisol level, which will be elevated, and is not suppressed by dexamethasone

Question 11

What can measurement of plasma ACTH help to distinguish

Answer 11

Pituitary cases from adrenal casues
Pituitary causes= raised ACTH
Adrenal causes= suppressed ACTH

Question 12

What is Addisons disease

Answer 12

A non specific disease with general tiredness, weakness and weight loss

Question 13

What is a key clinical clue indicating Addisons disease

Answer 13

hyperpigmentation generally seen over the whole skin but particularly prominent in the palmar creases of the hands, and on the buccal mucosa

Question 14

If we don’t manage Addisons disease what can happen

Answer 14

Can become Addisons crisis

Question 15

What are some feature of Addisons crisis

Answer 15

1. Vomitting
2. Loss of salt and water resultign in hypotension or hypoglycaemia
3. May result in coma

Question 16

How do we investigate for Addisons disease

Answer 16

Plasma cortical levels= will be low
ACTH may be raised
Adrenal autoantibodies
Real electrolytes and glucose also measured

Question 17

How is Addisons crisis managed

Answer 17

Intravenous hydrocortisone, glucose, and fluid and electrolyte replacement

Question 18

How is Addisons disease managed

Answer 18

hydrocortisone (cortisol) and fludrocortisone (aldosterone)

Question 19

What does aldosterone do

Answer 19

Stimulates retention of salt and loss of potassium via the kidneys

Question 20

In whom does conns syndrome occur in

Answer 20

People with a tumour or hyperplasia of the adrenal cortex resulting in high levels of aldosterone secretion

Question 21

What can high levels of aldosterone lead to

Answer 21

Potassium loss and sodium retention

Question 22

What can potassium loss lead to

Answer 22

Muscle weakness and polyuria

Question 23

What can sodium retention lead to

Answer 23

Hypertension

Question 24

What diseases/ disorders can the thyroid gland suffer from

Answer 24

1. Hyperthyroidism
2. Hypothyroidism

Question 25

What does the thyroid gland do

Answer 25

Secreted iodine containing hormones thyroxine and triiodothyronine

Question 26

What is overproduction of the thyroid hormone also known as

Answer 26

Hyperthyroidism or thyrotoxicosis

Question 27

Give an example of hyperthyroidism

Answer 27

Graves Disease

Question 28

What is Graves disease caused by

Answer 28

An antibody that binds to the thyroid stimulating hormone (TSH) receptor on the thyroid cells and stimulates it

Question 29

Give some causes of hyperthyroidism

Answer 29

1. Thyroid adenoma 2. Toxic multi nodular goitre 3. Graves disease

Question 30

What does goitre mean

Answer 30

applies to a swelling of the thyroid gland

Question 31

What are some symptoms of hyperthyroidism

Answer 31

1. Weight loss 2. Dislike of heat 3. Tremor 4. Irritability 5. Emotionally labile

Question 32

What are some signs of hyperthyroidism

Answer 32

1. Tachycardia 2. Atrial fibrillation 3. Tremor 4. Enlarged thyroid 5. Exophthalmos Goitreo

Question 33

What is the treatment for hyperthyroidism

Answer 33

1. Carbimazole 2. Partial thyroidectomy 3. Radioactive iodine

Question 34

Why do patients with hyperthyroidism lose weight without trying

Answer 34

Due to increased metabolic rate

Question 35

Where might a patent with hyperthyroidism present with a goitre

Answer 35

front of the larynx in the neck which might move upwards on swallowing can be lumpy or smooth

Question 36

Give some signs and symptoms of graves disease

Answer 36

1. Smooth goitre 2. Protrusion of the eyes (exophthalmos) 3. Double vision 4. Thyroid acropachy (fingernail clubbing) 5. Thickening of the shins and dorsum of the foot

Question 37

How can hyperthyroidism be investigated

Answer 37

Measurement of free plasma of t4 and t3 = will be raised Thyroid secretion hormone will be suppressed

Question 38

What is hypothyroidism

Answer 38

Severely underactive thyroid

Question 39

What is a key characteristic of hypothyroidism

Answer 39

Deposition of mucinous material in the subcutaneous tissues - MYXOEDEMA

Question 40

Describe the blood biochemistry of a patient with hypothyroidism

Answer 40

Low levels of T4 and T3 High thyroid secretion hormone

Question 41

What can hypothyroidism be caused by

Answer 41

1. Spontaneous due to primary autoimmune disease 2. Drug induced eg antithyroid drugs 3. Iodine deficiency 4. radioiodine therapy or surgery to the thyroid gland

Question 42

What are the symptoms of hypothyroidism

Answer 42

1. Weight gain 2. Dislike of cold 3. lethargy 4. Depression 5. Puffy features eg bags under the eyes 6. Deep and croaky voice

Question 43

What are some of signs of hypothyroidism

Answer 43

1. Bradycardia 2. Goitre 3. Dry skin and hair

Question 44

How id hypothyroidism managed

Answer 44

Thyroxine replacement

Question 45

What can hypothyroidism drugs be classified into

Answer 45

1. Antithyroid drugs 2. Iodide 3. Radioactive iodine.

Question 46

Other than thyroxine drugs what else might a person with hypothyroidism take

Answer 46

β-adrenergic-blocking drugs can be used to manage symptoms of thyrotoxicosis such as tremor and tachycardia

Question 47

Give examples of antithyroid drugs

Answer 47

thioureylenes, carbimazole propylthiouracil

Question 48

How are antithyroid drugs work

Answer 48

By prevention of incorporation of iodine into the thyroid hormones levothyroxine and tri-iodothyronine

Question 49

What considerations should we taken dentally in a patient with hyperthyroidism

Answer 49

Contra indication to the use of adrenaline Opportunistic infection such as oral candidiasis may occur