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Endocrine > Thyroid > Flashcards

Thyroid Flashcards

1
Q

What is the location of the thyroid?

A

In the anterior neck between the C5 and T1 vertebra

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2
Q

Are males or females more affected by thryoid disease?

A

Females (about 5-10 times as much)

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3
Q

What is the definition of thyrotoxicosis?

A

Excess thyroid hormone in the blood

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4
Q

What is the definition of hyperthyroidism?

A

Overproduction of thyroid hormone

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5
Q

What is the definition of hypothyroidism?

A

Under production of thyroid hormone

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6
Q

Give 3 reasons for increased levels of thyroid hormone

A
  1. Hyperthyroidism
  2. Leakage of preformed hormone from the thyroid (due to autoimmune of infection destruction of the follicular cells)
  3. Ingestion of excess thyroid hormone
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7
Q

Give 4 predisposing factors to thyroid autoimmunity

A
  1. Genetics e.g. HLA
  2. Environment (including diet, smoking, stress, iodine levels etc)
  3. Endogenous factors e.g. sex hormones, glucocorticoids, pregnancy
  4. Being female
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8
Q

What are the 2 main antibodies involved in thyroid autoimmunity?

A

Thyroglobulin and thyroid peroxidases (TPO) antibodies

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9
Q

How is thyroid cell destruction mediated?

A

By cytotoxic T cell (CD8+)

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10
Q

What is a goitre?

A

A palpable and visible thyroid enlargement due to a variety of causes

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11
Q

What are the 2 types of goitre?

A
  1. Diffuse smooth

2. Nodular (multi and single)

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12
Q

What are some causes of a diffuse smooth goitre?

A
  • Graves’ disease
  • Thyroiditis
  • Iodine deficiency
  • Medications (e.g. lithium, amiodarone)
  • Hereditary factors
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13
Q

What are some causes of a single nodular goitre?

A
  • Cyst
  • Adenoma
  • Carcinoma
  • Other rare causes
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14
Q

What is the difference between primary and secondary hyperthyroidism?

A

Primary is due to a thyroid pathology whereas secondary is due to thyroid stimulation by excess TSH

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15
Q

What is the most common cause of hyperthyroidism?

A

Graves’ disease

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16
Q

Give the 3 more common causes of hyperthyroidism

A
  1. Graves’ disease (most common – 75-80% of cases)
  2. Toxic multinodular goitre
  3. Toxic adenoma (benign)
17
Q

Give some less common causes of hyperthyroidism

A
  1. Exogenous/drug induced (iodine/T4 excess)
  2. Ectopic thyroid tissue (metastases)
  3. Subacute, postpartum and silent thyroiditis
18
Q

Give some clinical features of hyperthyroidism

A
  • Weight loss
  • Tachycardia
  • Hyperphagia (excessive eating)
  • Anxiety
  • Tremor
  • Heat intolerance
  • Sweating
  • Diarrhoea
  • Menstrual disturbance
  • Lid lag and ‘stare’
19
Q

How would you investigate and diagnose hyperthyroidism?

A
  • Thyroid function tests
  • Thyroid antibodies
  • Isotope uptake scan
  • Diagnosis of underlying cause
  • Clinical history and physical signs
20
Q

What would you expect to see from the TFTs of primary and secondary hyperthyroidism?

A
  • Primary: increased [free T4], increased [free T3], supressed TSH
  • Secondary: increased [free T4], increased [free T3], inappropriately high TSH
21
Q

How would you treat hyperthyroidism?

A
  • Beta blockers for rapid symptom control
  • Anti-thyroid drugs (a course or long-term)
  • Radioiodine (I-131)
  • Surgery
22
Q

What is the most common cause of primary hypothyroidism?

A

Iodine deficiency

23
Q

Give some causes of primary hypothyroidism

A
  • Autoimmune/atrophic hypothyroidism
  • Hashimoto’s thyroiditis
  • I-131 therapy
  • Thyroidectomy
  • Post-partum thyroiditis
  • Iodine deficiency
  • Drug induced e.g. carbimazole, lithium, amiodarone
  • Thyroid hormone resistance
24
Q

What causes secondary hypothyroidism?

A

Pituitary or hypothalamic disease

25
Q

Give some clincal symptoms of hypothyroidism

A
  • Hoarse voice
  • Goitre
  • Constipation
  • Cold intolerant
  • Weight gain
  • Menorrhagia
  • Myalgia, weakness
  • Tired, low mood, dementia
  • Myxoedema
26
Q

Give some clincal signs of hypothyroidism

A
  • Bradycardia
  • Reflexes relax slowly
  • Ataxia (cerebellar)
  • Dry, thin hair/skin
  • Yawning/drowsy/coma
  • Cold hands +/- temperature drop
  • Ascites
  • Round puffy face
  • Defeated demeanour
  • Immobile +/- Ileus (temporary arrest of intestinal peristalsis)
  • Congestive cardiac failure
27
Q

What would TFTs and blood tests for primary hypothyroidism show?

A
  • Raised TSH (most sensitive marker)
  • Usually decreased [free T4]
  • Decreased [free T3]
  • T4/T3 may be low in mild hypothyroidism
  • +ve titre of TPO antibodies in Hashimoto’s
28
Q

What would TFTs and blood tests for secondary hypothyroidism show?

A

TSH inappropriately low for reduced T4/T3 levels

29
Q

What is the diagnostic marker for hypothyroidism?

A

Serum free T4 being low

30
Q

How do you treat hypothyroidism?

A

Lifelong synthetic L-thyroxine (T4) hormone replacement e.g. oral levothyroxine

Endocrine (7 decks)

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