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RE > Thyroid disease > Flashcards

Thyroid disease Flashcards

1
Q

What does a structural assessment of the thyroid gland involve?

A

Assessing size of thyroid;
Normal
Reduced or absent
?Ectopic
Enlarged - Goitre
Physiological
Pathological

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2
Q

What are the physiological reasons for thyroid gland enlargement?

A

Adolescence
Pregnancy

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3
Q

What does a functional assessment of the thyroid involve?

A

Assessing how well it’s functioning;
Euthyroid
Hypothyroid (Underactive)
Hyperthyroid (Thyrotoxic)

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4
Q

What is the preferred imaging technique for the thyroid?

A

USS

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5
Q

When does the foetal thyroid develop and start thyroxine production?

A

By week 12, thyroxine production by week 16.

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6
Q

Why is maternal thyroid supply important in a foetus?

A

Helps neurological development

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7
Q

Which developmental problems can there be with the thyroid gland?

A

Congenital hypothyroidism
Aberrant/Ectopic thyroid gland
Thyroglossal cyst

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8
Q

What does a TFT involve?

A

Testing for TSH, FT4 and FT3.

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9
Q

Which hormones are affected in hypothyroidism?

A

TSH high
FT4 low

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10
Q

Which hormones are affected in hyperthyroidism?

A

TSH low
FT4 and FT3 high

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11
Q

TSH is the initial investigation of choice. When would T4 + T3 be tested?

A

Secondary/central hypothyroidism
Non-thyroidal illness
Recent treatment for thyrotoxicosis

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12
Q

Does TSH respond quickly to changes in the thyroid?

A

No, takes around 6 weeks for levels to be stable when there have been changes to the thyroid.

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13
Q

What are the normal serum levels for TSH, FT4 and FT3?

A

TSH - 0.3-3.5 mU/L
FT4 - 10-25 pmol/L
FT3 - 3.5 - 7.5 pmol/L

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14
Q

What specific symptoms and signs are there of hypothyroidism?

A

Cold intolerance
Facial puffiness
Dry skin
Hair less
Hoarseness
Heavy menstrual periods
Bradycardia
Stupor or coma

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15
Q

What risk factors are there for hypothyroidism?

A

Other autoimmune conditions e.g. T1DM or coeliac
Family history
Immune therapy for cancer - melanoma

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16
Q

What can happen to the thyroid in postpartum?

A

Patients can develop postpartum thyroiditis 8-20 weeks postpartum.

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17
Q

After treatment for which condition can hypothyroidism occur?

A

Thyrotoxicosis
- if post surgery or post radioiodine

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18
Q

What is the difference between primary and secondary hypothyroidism?

A

Primary - high TSH, low T4 + T3. No negative feedback loop to reduce TSH.
Secondary - Low TSH, T4 + T4. Disease of pituitary or hypothalamus.

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19
Q

Which form of hypothyroidism is rare?

A

Secondary

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20
Q

What are the two types of hypothyroidism?

A

Primary and secondary

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21
Q

What are some causes of primary hypothyroidism?

A

Autoimmunity
Infection (thyroiditis)
Drug interactions
Congenital hypothyroidism
Iodine deficiency
Post hyperthyroidism treatment

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22
Q

What are some causes of secondary hypothyroidism?

A

Pituitary tumours
Tumours compressing hypothalamus
Sheehan syndrome
TRH resistance
TSH deficiency
Lymphocytic hypophysitis
Radiotherapy

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23
Q

How is hypothyroidism treated?

A

Levothyroxine (T4)
Liothyronine (T3) - less commonly. Short half life.

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24
Q

What is the half life of levothyroxine?

A

7-10 days

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25
Q

Why should the elderly generally have a lower dose of levothyroxine?

A

There is a risk of CCF

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26
Q

When should TSH be tested after starting levothyroxine?

A

After 4-6 weeks. Keep level around 2 mU/L

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27
Q

If someone is taking levothyroxine, does their dosage change in pregnancy?

A

Yes - increases by 25-30%

28
Q

What can happen in severe hypothyroidism?

A

Myxoedema
- Endocrine emergency - high mortality

29
Q

What are the clinical features of a myxoedema?

A

Decreased mental status and hypothermia
Bradycardia
Hypotension
Hypoglycaemia
Myxoedematous face - peripheral oedema

30
Q

How is myxoedema treated?

A

Supportive management - ITU
IV levothyroxine + occasionally T3
IV Hydrocortisone 200-400mg daily

31
Q

What are the specific symptoms of hyperthyroidism?

A

Weight loss
Shakes
Palpitations
Loose bowels

32
Q

What are some causes of hyperthyroidism (Thyrotoxicosis)?

A

Graves disease (autoimmune)
Thyroiditis
Toxic multi nodular goitre
Toxic adenoma
Drug induced

33
Q

Which drugs can cause thyrotoxicosis?

A

Amiodarone
Lithium

34
Q

Which eye problem can thyrotoxicosis present with?

A

Thyroid eye disease

35
Q

Which biochemical changes can be seen in thyrotoxicosis?

A

Liver - Transaminitis (AST, ALT, ALT)
Bone - High ALP, hypercalcaemia
Pancytopenia or neutropenia

36
Q

Why does Graves disease occur?

A

Autoantibody (Ig) binds to thyroid epithelial cells, mimicking the stimulatory action of TSH.
Binds to TSH receptor, and increases thyroid activity.
This causes T4 + T3 to increase and the thyroid to grow –> goitre.

37
Q

What are the symptoms of thyroid eye disease?

A

Inflammation of orbital tissues (not the eye)
Itchy, dry eyes
Prominent eyes

38
Q

What are the signs of thyroid eye disease?

A

Diplopia/loss of sight
Loss of colour vision
Redness and swelling of conjunctiva
Inability to close eyes
Aching and pain behind eyes

39
Q

What is the name for when eyes are protruding?

A

Proptosis

40
Q

What is a toxic adenoma?

A

Abnormal growth - ‘nodule’ either solid or fluid filled.
Generates excess thyroid hormones.
Usually benign.

41
Q

What is a toxic multi nodular goitre?

A

Multiple nodules in the thyroid that generates excess thyroid hormones.
Usually benign.

42
Q

What are the five types of thyroiditis?

A

De Quervain’s thyroiditis
Postpartum - autoimmune
Drug induced - damages thyroid tissue
Radiation indued
Acute/infectious

43
Q

What causes De Quervain’s thyroiditis?

A

Viral infection.
Painful.

44
Q

How is hyperthyroidism treated?

A

Medication - Carbimazole or Propylthiouracil

45
Q

What can happen is hyperthyroidism is not treated?

A

Symptoms escalate e.g. Graves disease
AF
Osteoporosis

46
Q

What is the MOA of Carbimazole and Propylthiouracil?

A

Inhibit thyroid peroxidase leading to a reduction of T4 and T3.

47
Q

How long is the medical treatment of hyperthyroidism usually for?

A

18-24 months to reduce the risk of relapse

48
Q

Which dangerous side effect can occur with Thyroid peroxidase inhibitors (Carbimazole and Propylthiouracil)?

A

Agranulocytosis
High mortality, takes 2 weeks to resolve.
Sore throat, mouth ulcer and infection.

49
Q

What two options are there for treating hyperthyroidism with Carbimazole?

A

Start high then reduce as thyroid function settles
Continue high dose then add thyroxine

50
Q

How does I131 Radiotiodine (RAI) treat hyperthyroidism?

A

I131 concentrates in thyroid
B radiation destroys the cells to make thyroid euthyroid or hypothyroid.

51
Q

Can a total or sub-total thyroidectomy for hyperthyroidism when a patient is still hyperthyroid?

A

No - patient needs to be euthyroid first.

52
Q

What are some risks of a total or sub-total thyroidectomy?

A

Hypothyroidism
Hypoparathyroidism
Vocal cord palsy (recurrent laryngeal nerve damage)

53
Q

How is a thyroid adenoma or multi-toxic goitre treated?

A

Medical treatment to control thyroid function then curative treatment with I131.

54
Q

How is thyroid eye disease treated?

A

To treat thyrotoxicosis;
Immunosuppressants
Steroids
Radiotherapy
To treat eye;
Orbital decompression
Eye surgery

55
Q

Which rare complication can there be in Grave’s disease that has a high mortality risk?

A

Thyroid storm (thyrotoxic crisis)

56
Q

What can trigger a thyroid storm?

A

Surgery
Pregnancy
Acute severe illness

57
Q

What are the symptoms of a thyroid storm (thyrotoxic crisis)?

A

Hyperpyrexia
CVS - Tachycardia >140bpm, arrhythmia, HF
CNS - Low GCS, agitation, delirium
GI - Nausea/vomiting, deranged LFTs

58
Q

What is the management of a thyroid storm?

A

Supportive treatment
B-blockers for tachycardia
Antithyroid medication - Propylthiouracil (PTU) - prevents peripheral conversion of T4 to T3
Iodine solution
Steroids and bile acid sequestrant

59
Q

What are the common causes of goitres?

A

Hashimoto thyroiditis
Graves disease
Familial or sporadic multi nodular goitre
Iodine deficiency
Follicular adenoma
Colloid module or cyst
Thyroid cancer

60
Q

What increases the risk of a goitre developing?

A

Malignancy
Family history
<20 or >60
Male
Radiation exposure

61
Q

What is involved in the palpation of a thyroid examination?

A

Hands - erythema hot or cold
Face - coarse facies
Eyes - exophthalmos
Trunk - Proximal myopathy (hyper/hypothyroid)
Legs - Pretibial myxoedema (Graves’ disease), brisk or slow relaxing reflexes
Percussion and auscultation

62
Q

What dose of Carbimazole is usually given for thyrotoxicosis?

A

FT4 <30pmol/L - 20mg OD
FT4 >30pmol/L - 40mg OD

63
Q

What are the two types of Auto antibodies?

A

Destructive - target the thyroid
Stimulatory - Target TSH receptor

64
Q

TPO antibodies increase the risk of developing what in the next 10 years?

A

Hypothyroidism

65
Q

Which antibody can cause thyroid diseases?

A

TSH receptor antibody

66
Q

Why is surgery not done unless a patient is euthyroid?

A

Risk of thyroid storm - removing thyroid will release hormones into circulation.
CVS risk due of anaesthetic due to increases hormones

RE (18 decks)

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