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Y2 Endocrine > Thyroid > Flashcards

Thyroid Flashcards

1
Q

is primary thyroid disease always autoimmune

A

no

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2
Q

normal descent of thyroid gland

A

foramen caecum - thyroglossal duct

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3
Q

management of sick euthyroid syndrome

A

repeat thyroid functions tests 6-8wks later when illness cured

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4
Q

risk of untreated congenital hypothyroidism

A

cretinism

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5
Q

most common thyroid function test abnormality in pregnancy

A

> fT4

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6
Q

gender more commonly affected by hypothyroidism

A

women

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7
Q

age more commonly affected by hypothyroidism

A

> 65 (if young autoimmune cause more likely)

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8
Q

other conditions associated with hypothyroidism

A

T1DM, Addison’s, CF, PBC

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9
Q

name of autoimmune cause of hypothyroidism

A

hashimoto’s thyroiditis

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10
Q

commonest cause of hypothyroidism

A

hashimoto’s

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11
Q

gender most commonly affected by hashimoto’s

A

women

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12
Q

is hashimoto’s goitrous

A

yes

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13
Q

auto-antibodies present in hashimoto’s

A

thyroid peroxidase TPO Ab, anti-thyroglobulin Ab

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14
Q

name causes of primary goitrous hypothyroidism

A

Hashimoto’s, iodine deficiency, amiodarone, lithium, maternally transmitted

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15
Q

genetic mututation in hashimoto’s thyroiditis

A

HLA CTLA-4/ PTPN-22

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16
Q

name causes of primary non-goitrous hypothyroidism

A

atrophic, post-ablative/radiotherapy, congenital

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17
Q

name causes of secondary hypothyroidism

A

infiltrative, infection, TSHoma, trauma, congenital, cranial radiotherapy, drug induced

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18
Q

what are the reproductive related presentations of hypothyroidism

A

menorrhagia, amenorrhea, hyperprolactinaemia

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19
Q

what are the msk related presentations of hypothyroidism

A

stiff muscle, peripheral neuropathy, long tendon jerk, carpal tunnel, cold intolerance

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20
Q

what are the derm related presentations of hypothyroidism

A

pale cool doughy skin, vitiligo, hypercarotenemia, coarse/sparse hair

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21
Q

what are the neuro related presentations of hypothyroidism

A

depression, psychosis, decreased intellect, decreased visual acuity

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22
Q

what are the gi related presentations of hypothyroidism

A

increased wt, decreased appetite, constipation, ascites, hoarse voice

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23
Q

what is seen on examination of the face in a patient with hypothyroidism

A

macroglossia, dull expresionless face, periorbital puffiness, coarse hair

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24
Q

what are the cardio related presentations of hypothyroidism

A

pitting oedema, <hr>lipids, worse HF, sleep apnoea

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25
Q

finding of thyroid function tests in primary hypothyroidism

A

decreased fT3/4, increased TSH

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26
Q

finding of thyroid function tests in secondary hypothyroidism

A

decreased fT3/4, decreased TSH

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27
Q

what drug is a cause of hypothyroidism

A

amiodarone

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28
Q

what would you see on thyroid function tests caused by amiodarone

A

decreased fT3, increased fT4, normal TSH

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29
Q

what would you see on thyroid function tests in subclunical hypothyroidism

A

increased TSH, normal fT3/4

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30
Q

management of hypothyroidism in a young patient

A

500-100 micrograms levothyroxine

31
Q

management of hypothyroidism in an elderly patient

A

25-50 micrograms levothyroxine

32
Q

management of hypothyroidism in a pregnant patient

A

increase dose by 25 micrograms and titrate upwards

33
Q

how do you monitor hypothyroidism

A

TSH

34
Q

how often do you monitor hypothyroidism

A

every 12- 18 monthes

35
Q

why do you slowly change doses of levothyroxine

A

arrhythmia risk

36
Q

what are the risks of hypothyroidism in pregnancy

A

stillbirth, eclampsia, abort, haemorrhage, premature

37
Q

which gender is more commonly affected by hyperthyroidism

A

woman

38
Q

what are some risk factors for hyperthyroidism

A

smoking, family history, woman, history of autoimmune disease

39
Q

what is the most common type of primary hyperthyroidism

A

grave’s disease

40
Q

what is the second most common type of primary hyperthyroidism

A

toxic multinodular goitre

41
Q

give an example of secondary hyperthyroidism

A

TSH secreting adenoma

42
Q

is a T3 secreting adenoma primary or secondary hyperthyroidism

A

primary

43
Q

which auto-antibodies are found in grave’s disease

A

TRAbs

44
Q

which clinical features of hyperthyroidism are specific to grave’s disease

A

acropachy, pretibial myxedema, eye disease

45
Q

what eye disease is found in grave’s disease

A

diplopia, proptosis, exopthalmus

46
Q

what is the pattern of thyroid disease in de quervain’s thyroiditis

A

hyperthyroid then hypothyroid

47
Q

what is the management of de quervain’s thyroiditis

A

self limiting in several months

48
Q

what are the risk factors for de quervain’s thyroiditis

A

viral infection

49
Q

what are the cardio related presentations of hyperthyroidism

A

atrial fibrillation, palpitations, heart failure, tachycardia

50
Q

what are the gi related presentations of hyperthyrodism

A

weight loss, increased appetite, diarrhoea, sweats

51
Q

what are the neuro related presentations of hyperthyroidism

A

tremor, anxiety, nervous, irritable, hyperkenesis

52
Q

what is seen of examination of the face in hyperthyroidism

A

lid lag, lid retraction, proptosis, brittle hair, thin hair, sweaty

53
Q

what are the reproductive related presentations of hyperthyroidism

A

lighter or less frequents periods, infertility, loss of libido

54
Q

what is the management of a thyroid storm

A

iodine, corticosteroids, PTU, b-blocker

55
Q

what are the findings on thyroid function tests in primary hyperthyroidism

A

increased fT3/4 and decreased TSH

56
Q

what are the findings on thyroid function tests of secondary hypertension

A

increased fT3/4 and increased TSH

57
Q

what is the appropriate next investigation for hyperthyroidism if unclear results of thyroid function tests

A

isotope scan

58
Q

what are the findings on thyroid function tests in subclinical hyperthyroidism

A

decreased TSH, normal fT3/4

59
Q

what drug are given first given first line for hyperthyroidism

A

carbimazole

60
Q

what drug other than carbimazole is added if the patient had cardio related clinical findings

A

propanolol (if asthma CCB)

61
Q

what is the management of hyperthyroidism in pregnancy

A

propylthiouracil in 1st trimester. after use low dose carbimazole

62
Q

what are the side effects of carbimazole

A

itch, teratogen, arthralgia, ALF, agranulocytosis

63
Q

what is the first presentation of agranulocytosis

A

dry cough, sore throat

64
Q

what are the side effects of PTU

A

liver failure

65
Q

what is the mechanism of carbimazole

A

inhibits TPO

66
Q

what is the mechanism of PTU

A

inhibits DIO1

67
Q

what is the management of a relapse of grave’s disease

A

radioiodine RAI

68
Q

what is a contraindication to radioiodine treatment of hyperthyroidism

A

pregnancy, eye disease

69
Q

what is a side effect of radioiodine treatment of hyperthyroidism

A

hypothyroidism, can’t see children for several weeks

70
Q

what is the management of hyperthyroidism if radioiodine is contraindicated

A

sub-total thyroidectomy

71
Q

what are the possible complications of a sub-total thyroidectomy

A

recurrent laryngeal palsy, scar, hypothyroidism, hyperparathyroidism

72
Q

what is the management of toxic multinodular goitre

A

surgery / radioiodine

73
Q

what condition does hyperthyroidism in pregnancy have a similar presentation to

A

hyperemesis

Y2 Endocrine (10 decks)

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