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Thyroid problems EAR:2 > Thyroid disease > Flashcards

Thyroid disease Flashcards

1
Q

What do the thyroid hormones do

A

Increase metabolism of CHO, protein and fat

Increase O2 consumption

Synergistic with actions of catecholamines

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2
Q

What are the two types of goitres

A

Diffuse (spread over the neck)

Nodular (discrete area that is clearly different from surrounding thyroid gland

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3
Q

What is a goitre

A

Enlarged thyroid gland (non specific term for any enlargement of the thyroid gland)

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4
Q

When would diffuse goitres be formed

A

When there is over-stimulation of the thyroid gland by either TSH or TSI (Graves’ disease)

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5
Q

Different causes of hypothyroidism

A
  • PRimary ofailure of thyroid gland (Hashimoto’s thyroiditis)
  • Secondary to hypothalamic or anterior pituitary failure
  • Lack of dietary iodine
  • Drug induced
  • Thyroid hormone resistance
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6
Q

What is Hashimoto’s thyroiditis and what are the plasma concentrations of hormones with this disease?

IS there a goitre present

A

Autoimmune disease of the thyroid

Low T3 and T4
High TSH

Goitre present

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7
Q

What are the plasma concentrations of hormones like in hypothyroidism caused. by hypothalamic or anterior pituitary failure?

IS there a goitre present

A

Low T3 and T4
Low TSH

No goitre

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8
Q

What are the plasma concentrations of hormones like in hypothyroidism caused by lack of dietary iodine

IS there a goitre present

A

Low T3 and T4
High TSH

Goitre present

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9
Q

Symptoms of hypothyroidism

A 
Weight gain
Dry skin
Hoarse voice, slow speech 
Cold intolerance
Constipation
Lowered HR/BP
Depression, confusion, poor memory

Some may get myxoedema- puffy appearance in face, hands and feet

Reduction in BMR and overall metabolic activity

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10
Q

How is BMR and metabolic activity like in hypothyroidism

A

Reduction in both

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11
Q

What is facial myxoedema

A

round, moon like
Puffy, pale, oedematous eye-lids
Thickened skin and dry

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12
Q

How are new-borns tested for cretinism

A

By testing for TSH and T4

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13
Q

How are primary and secondary hypothyroidism tested

A

Thyroid function test

Primary: low T3 and T4, high TSH

Secondary: Low T3 and T4, low TSH

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14
Q

If you suspect Hashimoyo’s what tests would you do

A

Test for thyroid antibodies

TPO, anti-thyroglobulin antibodies

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15
Q

What is the management of hypothyroidism

A

T4 (treatment of choice)

T3

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16
Q

How is T4 taken and what are the cautions

How to overcome these complications

A

Orally, once a day

  • May worsen or uncover angina
  • -> If angina, beta blocker is prescribed. Baseline ECG given with initial dosage
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17
Q

Why is T3 not routinely given for hypothyroidism? When is it used

A

Has a rapid onset and this can induce heart failure

Used in severe hypothyroid states when rapid response is desired (i.v.)

18
Q

What are the causes of hyperthyroidism

A
  • Abnormal levels of thyroid stimulating immunoglobulins (Graves’ disease)
  • Secondary to excess hypothalamic or anterior pituitary secretion
  • Hyper-secreting thyroid tumour
  • Latrogenic causes
19
Q

What are the plasma conc of hormones in hyperthyroidism caused by Graves’ disease and is. goitre present

A

High T3 and T4
Low TSH

Goitre present

20
Q

What are the plasma conc of hormones in hyperthyroidism caused by secondary to excess hypothalamic or anterior pituitary secretion

A

High T3 and T4
High TSH

Goitre present

21
Q

What are the plasma conc of hormones in hyperthyroidism caused by hyper-secreting thyroid tumour

A

High T3 and T4
Low TSH

Goitre present

22
Q

What does TSI (thyroid stimulating immunoglobulins do )

A

Activate the thyroid gland (by binding to TSH receptors on thyroid gland) to produce and release thyroid hormones

23
Q

What is the most common cause of hyperthyroidism

A

Graves’ disease

24
Q

Classic signs and symptoms of Graves’ disease

A 
Weight loss
Sweating 
Heat intolerance
Palpitations
Tremor
Nervousness
Goitre
Exophthalmos (bulging eyes)
25
Q

symptoms of hyperthyroidism

A 
Weight loss
Sweating
Heat intolerance
Diarrhoea
Palpitations
Tremor
Anxiety, emotional, irritable 
Restlessness
26
Q

What is the increased cellular/tissue metabolism due to in hyperthyroidism

A

excessive thyroid hormone action

27
Q

What is also enhanced in hyperthyroidism

A

Beta adrenoceptor responses

28
Q

How to diagnose hyperthyroidism

A

primary - high T3 and T4, low TSH

Secondary- high T3 and T4, high TSH

29
Q

If you suspect Graves’ disease, what tests do you do

A

Test for thyroid-stimulating antibodies

30
Q

If you suspect thyroid tumours, what tests do you do

A

Thyroid uptake test using radioactive Iodine

31
Q

what is the goal of treatment for hyperthyroidism

A

Euthyroid state and symptomatic relied from increased sympathetic activity

32
Q

Management of hyperthyroidism

A

Anti-thyroid drugs
Radioiodine
Surgery

33
Q

What are anti-thyroid drugs

A

Thionamides (carbimazole and propylthyiouracil(PTU))

34
Q

What is the mode of action of anti-thyroid drugs

A

Decrease production of thyroid hormones by inhibiting iodination and coupling processes via TPO

-PTU also block T4 to T3 deionidation

35
Q

HOw long do anti-thyroid drugs take to work

A

Several weeks because of colloid stores

36
Q

What is the drug of choice for hyperthyroidism and what are the complications

A

Carbimazole but
-rashes and pruritis common

-Rare complication: neutropenia and agranulocytosis (bone marrow suppression) which are reversible

37
Q

What drugs can be used to manage hyperthyroidism

A

Thionamides (anti-thyroid drugs)

Non-selective beta blockers

38
Q

What is the action of non-selective beta blockers for managing hyperthyroidism and what they do

A

Reduce actions of catecholamines

-rapid symptomatic relief od tremor, palpitations, and anxiety

39
Q

What are the two approaches used with anti-thyroid drugs

A

Dose titration- where only anti-thyroid drugs are used. Doses are adjusted to achieve normalisation of thyroid hormone production

Block and replace- where anti-thyroid drugs are given with thyroxine replacement

40
Q

How do the two methods used with anti-thyroid drugs for hyperthyroidism compare

A

Both are equally effective

Dose titration method associated with a lower rate of side effects

41
Q

When is radioactive iodine used and what is the possible complication

A

First line for older patients with nodular goitres and hyperthyroidism

Used when hyperthyroidism recurs after anti-thyroid drug therapy

-HYpothyroidism may result

42
Q

When is thyroidectomy used (removal of some or all of thyroid)

What is the possible complication

A

When severe hyperthyroidism associated with a large goitre or concern about tumour development

Also used when there are obstructive symptoms

-Hypothyroidism may result

Thyroid problems EAR:2 (6 decks)

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