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Flashcards in Thyroid Deck (43):
1

What are the symptoms of hypothyroidism?

Lethargy; cold intolerance; reduced appetite; increased weight; constipation; menorrhagia; depression

2

What are the signs of hypothyroidism?

cold hands
bradycardia
slow-relaxing reflex
dry hair and skin
puffy face
goitre
myopathy/ neuropathy
ascites
myxoedema ( swelling of the eye and back of the hands)

3

What are the causes of hypothyroidism?

Primary
atrophic thyroiditis
Hashimoto's
Iodine deficiency
Drugs: carbimazole, amiodarone, lithium

Subacute thyroiditis ( e.g. post-partum)
post de Quervain,s thyroiditis
Congenital: thyroid agenesis

Post-surgical
Thyroidectomy
Radioiodine

Secondary
Hypopituitarism ( very rare)

4

What is atrophic thyroiditis?

auto-immune disease
Antibodies block receptors in the thyroid > the thyroid shrinks as it no getting used (atrophy - no goiter)
lymphocytic infiltrate
Look for anti- TSH and anti-TPO

Associations
pernicious anemia
vitiligo
endocrinopathies


5

What is Hashimoto's thyroiditis?

thyroid peroxidase antibodies (TPO)
atrophy+ regeneration = firm painlkess non-tender goite
may go through initial thyrotoxicosis phase
man be euthyroid or hypothyroid

6

What blood tests would you do for ptx with hypothyroidism? and what would the results be?

FBC - anaemia
TSH ( High)
T3/4 ( low)
MCV ( machromic or normochromic)
U&E - hyponatraemia
ABs - TOP, TSH. Anti-TSH, anti-TPO
CK - can be raised if myopathy

7

What is the treatment for hypothyroidism?

Levothyroxine
Look for other auto-immune diseases e.g. Addison's pernicious anemia

8

What is a myxoedema coma?

Is it severe state of hypothyroidism
Usually in the elderly.

Primary symptoms of myxedema coma are altered mental status and low body temperature.

Low blood sugar, low slowed heart rat low blood pressure, hyponatremia, hypercapnia, hypoxia, e, and hypoventilation may also occur.

Myxedema, although included in the name, is not necessarily seen in myxedema coma

9

Name some precipitants to a Myxoedema coma?

infection, trauma, MI, stroke
radioiodine
Surgery - thryoidecctomy Pituitary surgery

10

What is the management of myxoedema coma?

Bloods - TFT, FBC, U&E, glucose, cortisol
correct any hypoglycemia
T3/4 slowly
Hydrocortisone 100mg IV
Rx hypothermia and heart failure

11

What are the key features of a simple goite?

Diffuse painless goitre

mass effects = dysphgia, stridor, SVC obstruction

Can be either euthyroid or hypothyroid

Causes
Same as multinodular gotire
iodine deficiency, autoimmune , goitrogens * e.g. sulphonylureas, hereditary ( dyshormorgenic )

12

What are the key features of a multinodular goite?

evolves from long-standing simple goitre

mass effects = dysphgia, stridor, SVC obstruction

Euthyroid or sub-clinical hyperthyroid

Causes
Same as simple gorti
iodine deficiency, autoimmune ( e.g. hashi), goitrogens * e.g. sulphonylureas, hereditary ( dyshormorgenic )

13

what are the key features Plummer's (toxic multinodular goitre) ?

multinodular goitre
thyrotoxicosis
uneven iodine uptake with hot module
Can develop on a background of multinodular goitre

Treament
anti-thryroid drugs
total or subtotal thyroidectomy

14

What are the key features Riedel's thyroiditis?

hard fixed thyroid
mass effects = dysphgia, stridor, SVC obstruction
associated with retroperitoneal fibrosis

it is an autoimmune disease

treatment = consertvative

15

What are the key features follicular adenoma?

single thyroid nodule with or without thryotoxicosis ( majority are cold
? may get pressure symptoms

16

What are the key features of thyroid cysts?

solitary thyroid nodule
asymptomatic or pressure symptoms localized pain due to cyst bleed

Aspiration or excision

17

what are the features of subacute lymphocytic thyroiditis?

painless goitre

hyperthyroidism phase to eu phase to hyrpo phase to eythyroid state ( normaly self limiting)

A variant of subacute lymphocytic thyroiditis occurs postpartum, postpartum thyroiditis

18

What are the symptoms of thyrotoxicosis?

irritability
palpitations
tremor
sweats, heat intolerance
increased appetite, but reduced weight
Diarrhoea
oligomenorrhoea ( infertility)

19

What are the signs of thyrotoxicosis ?

Hand
fast/irregular pulse
warm, moist skin
fine tremor
palmer erythema

Face
thin hair
lid lag
lid retraction


Neck
goitre or modules

20

what are the Graves' specific signs?

ophthalmopathy
exophthalmos
ophthalmoplegia eps. on up-gaze palsy
eye discomfort and grittiness
photophobia
reduced acuity
chemosis - is the swelling (or edema) of the
conjunctiva.
pre-tibial myxoedema
thyroid acripachy


21

What investigations would you do for thyrotoxicosis?

Tsh low
T3/4 high
abs ths receptor TPO
Ca high
LFT high
isotope scan - increased in graves
reduced in thyroiditis
ophthalmopathy : acuity, fields, movements

22

What factors can triggers Graves' disease

stress, infection, child-birth

23

What diseases are associated with Gaves?

TIDM
vitiligo
addison's

24

What drugs can cause thyrotoxicosis?

Amiodarone
Thyroxine

25

What are the key features toxic adenoma?

solitary hot nodule + producing t3/4

26

What is the management of thyrotoxicosis?

Medical
symptomatic: beta - blockers ( propranolol 40mg/6h)
anti-thyroid: carbimazole

Radiological - Radio-iodine
most become hypothyroid so need thyroxine
CI: prengancy, laction

surgical: thyroidectomy

27

what are the features of thyroid storm

increased temp
agitation, confusion, coma
tachycardia Af
acute abdomen
heart failure

28

what are the precipitating for a thyroid storm

infection
MI
trauma
recently thyroid surgery
radioiodine

29

What is the treatment for a thyroid storm?

Fluid resucitation + NGT
bloods TFT and cultes
propranolo po/iv
carbiomasole then lugol iodine 4h later
hydrocortisone
Rx cause

30

What are the key features of papillary thyroid cancer?

most common 80% age 20-40
more common in females

cell origin _ follicular
thyroglobulin marker high

spread: nodes and lungs

31

What is the treatment for papillary thyroid cancer?

total throidectomy +/- node excision +/- radioiodine
T4 to suppress TSH

32

What are the key features of follicular thyroid cancer

most common 10% age 40-60
more common in females

cell origin _ follicular
thyroglobulin marker high

spread: blood to bone and lungs

33

What is the treatment for follicular thyroid cancer?

total throidectomy +/- radioiodine
T4 to suppress TSH

34

What are the key features for medullary thyroid cancer?

accounts for 5% of thyroid cancer
30% are familial e.g. men 2
MENs: young
spiradic age: 40-50
cell origin parafollicular c-cells
markers _ CEA and calcitonin
amyloid deposits

35

What is the treatment for medullary thyroid cancer?

do phaeo screen pre-op
thyroidectomy + node clearance
consider radiotherapy

36

what are the key features of anaplastic thyroid cancer?

very rare
more commom in females
undifferentiated follicular cells
rapid growth
aggressive local, LN and blood

usually palliative
may try thyroidectomy and radiotherepy

37

What disease is Thyroid lymphoma associated with?

hashimoto's

38

What is the treatment for lymphoma of the thyroid?

chemo-radiotherapy

39

What are the indications for thyroid surgery?

pressuresymtoms
relapse hyperthyroidism ( failed more than 1 drug Rx)
carcinoma
cosmesis

40

What are the early complications of thyroid surgery?

reactionary haemorrhage which become a haematoma.
can cause airway obstruction

Laryngeal oedema
Damage during intubation or surgical manipulation
can cause airway obstruction
recurrent largngeal nerve palsy
right more common
damage to one causes hoarse voice
damaget to both causesobstruction needing trachyostomy

Hypoparatrhyroidism
throid storm

41

What are the late complications of thyroid surgery?

hypothroidism
recurrent hyperthyroidism
keloid scar

42

What is Sick euthyroid syndrome?

abnormal findings on thyroid function tests that occur in the setting of a nonthyroidal illness (NTI), without preexisting hypothalamic-pituitary and thyroid gland dysfunction. After recovery from an NTI, these thyroid function test result abnormalities should be completely reversible.

43

A 35-year-old female who has recently being diagnosed with Grave's disease presents for review 3 months after starting a 'block and replace' regime with carbimazole and thyroxine. She is concerned about developing thyroid eye disease. What is the best way that her risk of developing thyroid eye disease can be reduced?

Smoking is the most important modifiable risk factor for the development of thyroid eye disease