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Thyroid Disorders Flashcards

1
Q

What can go wrong with the thyroid?

A 
Decreased function - hypo
Increased function - hyper
Enlargement - nodular disease
Inflammation (AutoAb)
Cancer
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2
Q

Most common causes of hypothyroidism?

A

a. Iodine deficiency (most common worldwide)

In Aus:

b. Autoimmune chronic lymphocytic thyroiditis (Hashimoto thyroiditis, atrophic thyroiditis)
c. Congenital: error in synthesis of thyroxine
d. Rx: surgery for hyper in the past
e. Transient: silent thyroiditis including postpartum thyroiditis (rebound hypothyroid phase when thyroid is damaged after inflammation e.g. virus)

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3
Q

Ix of hypothyroidism?

A

TSH: elevated
Free T3: low
Free T4: low
Thyroid Ab (anti-TPO, anti- thyroglobulin)

  • Imaging is not indicated in hypothyroidism
  • Consider a thyroid US only if there is a palpable goitre
  • No need for nuclear scan
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4
Q

Sx of hypothyroidism - appearance

A 
Puffy, pale facies
Dry, brittle hair 
Dry, cool skin
Thickened brittle nails
Myxoedema
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5
Q

Sx of hypothyroidism - energy

A

Cold intolerance
Weight gain
Fatigue

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6
Q

Sx of hypothyroidism - nervous system

A

Headache

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7
Q

Sx of hypothyroidism - cognitive

A

d

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8
Q

Sx of hypothyroidism - Cardiovascular

A

d

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9
Q

Sx of hypothyroidism -

A

d

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10
Q

Sx of hypothyroidism -

A

d

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11
Q

Sx of hypothyroidism -

A

d

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12
Q

What is the difference between primary and secondary hypothyroidism?

A

Primary hypothyroidism - pathology of thyroid itself
(raised TSH, low free T3/T4)
Secondary hypothyroidism - pathology of higher centre (anterior pituitary - low TSH, low free T3, T4)

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13
Q

Rx of hypothyroidism

A

Thyroxine - 75-150mcg/day single dose (if young, healthy, pregnant)

Aim for TSH in low normal range

If patient has IHD or elderly, start with smaller dose at 25 mcg/day

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14
Q

Rx of hypothyroidism

What is the 1/2 life of treatment and how does that affect follow up?

What are the modifying factors of Rx?

A

Thyroxine - 75-150mcg/day single dose (if young, healthy, pregnant)

Half life: 1 week therefore steady state app. 6-8 weeks, only do blood test and adjust thyroxine dose after 6-8 weeks

Aim for TSH in low normal range

Modifying factors:
If patient has IHD or elderly, start with smaller dose at 25 mcg/day

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15
Q

What medications decrease thyroxine absorption?

A

Fe tablets, Ca tablets, antacids, cholestyramine

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16
Q

There is usually no hurry in hypothyrodism Rx except in…?

A

Pregnancy

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17
Q

Ix of hypothyroidism?

A

TSH: elevated
Free T3: low
Free T4: low
Thyroid Ab (anti-TPO, anti- thyroglobulin)

  • Recheck TFTs after 6 weeks (except in pregnancy)
  • Imaging is not indicated in hypothyroidism
  • Consider a thyroid US only if there is a palpable goitre
  • No need for nuclear scan
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18
Q

There is usually no hurry in hypothyrodism Rx except in…?

A

Pregnancy

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19
Q

T/F recheck TFTs later than 6 weeks

A

True - no point checking earlier

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20
Q

T/F adjust Rx earlier than 6 weeks

A

False - half life of thyroxine is 1 week therefore steady state is reached at 6-8 weeks (no point checking before)

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21
Q

T/F it is appropriate to request a nuclear scan in hypothyroidism

22
Q

Sx of hypothyroidism - cognitive

A

Depression

Delayed tendon reflexes

23
Q

Sx of hypothyroidism - Cardiovascular

A

Bradycardia
Pericardial effusion
Decreased exercise tolerance

24
Q

Sx of hypothyroidism - GIT

A

Constipation

Anorexia

25
Sx of hypothyroidism - reproductive
irregular and heavy menses | Infertility
26
T/F it is appropriate to request a nuclear scan in hypothyroidism
False
27
Relationship between pregnancy and hypothyroidism
Iodine supplementation should be prescribed routinely in women planning a pregnancy Maternal TFTs change during pregnancy in response to increased metabolic requirements and presence of fetus Therefore require trimester specific reference intervals
28
Relationship between pregnancy and hypothyroidism
Iodine supplementation should be prescribed routinely in women planning a pregnancy Maternal TFTs change during pregnancy in response to increased metabolic requirements and presence of fetus (esp. thyrotropic activity of B-hCG results in decrease in TSH in first trimester) Therefore require trimester specific reference intervals
29
Relationship between pregnancy and hypothyroidism
Iodine supplementation should be prescribed routinely in women planning a pregnancy Maternal TFTs change during pregnancy in response to increased metabolic requirements and presence of fetus (esp. thyrotropic activity of B-hCG results in decrease in TSH in first trimester) Therefore require trimester specific reference intervals
30
Relationship between pregnancy and hypothyroidism
Iodine supplementation should be prescribed routinely in women planning a pregnancy Maternal TFTs change during pregnancy in response to increased metabolic requirements and presence of fetus (esp. thyrotropic activity of B-hCG results in decrease in TSH in first trimester) Therefore require trimester specific reference intervals
31
Causes of thyrotoxicosis
a. Graves' disease b. Toxic nodular goitre (multinodular, solitary adenoma) c. Iodine - induced - radiographic contrast - naturapathic remedies - amiodarone d. Factitious (surreptitious thyroxine use) - for weight loss e. Transient (with thyroiditis)
32
Ix hyperthyroidism
a. TSH: Low (usually
33
Sx of hyperthyroidism
``` Heat intolerance Loss of weight Increase appetite Increase in sweating Tremor Anxiety, emotional lability Loss of hair increased f of bowel movements Menstrual irregularity ```
34
Signs of hyperthyroidism on Px ** finish with Talley xx
``` Increase HR and rhythm Tremore Skin, nail and hair changes Thyroid size, consistency, bruit Usually no cervical LNs Eyes: redness, irritation (conjunctival), exopthalmos, proptosis, lid lag, double vision ```
35
In a thyroid nuclear scan, what should the thyroid uptake be compared to?
in a normal thyroid nuclear scan, thryoid uptake is similar to salivary gland uptake
36
In a thyroid nuclear scan, what should the thyroid uptake be compared to?
in a normal thyroid nuclear scan, thryoid uptake is similar to salivary gland uptake
37
Rx of hyperthyroidism
1. Antithyroid drugs: a. Carbimazole b. Propylthiouracil (PTU) 2. Radioactive iodine 3. Surgery: only if other reasons such as - AFx to Rx, cosmetic, risk of malignancy
38
When do you use carbimazole?
used in most cases: - more effective except in first trimester: teratogenic
39
When do you use PTU?
1st trimester of pregnancy as carbimazole associated with teratogenic effects Not used as much: Liver failure
40
When do you use PTU?
1st trimester of pregnancy as carbimazole associated with teratogenic effects Not used as much: Liver failure
41
AFx of carbimazole and PTU?
Carbimazole: rash, prirutis (agranulocytosis - rare) PTU: agranulocytosis, liver damage
42
When do you use carbimazole?
* used in most cases - more effective except in first trimester: teratogenic
43
Rx of hyperthyroidism
1. Antithyroid drugs: a. Carbimazole (CBZ) b. Propylthiouracil (PTU) 2. Radioactive iodine 3. Surgery: only if other reasons such as - AFx to Rx, cosmetic, risk of malignancy
44
AFx of carbimazole and PTU?
Carbimazole: rash, prirutis (agranulocytosis - rare) PTU: agranulocytosis, liver damage
45
Outline in detail the Rx of Graves' disease
- Need to treat 12-18 months - 10-40mg carbimazole a day - Adjust dose over 6 weeks (gradual reduction in doses depending on clinical state)
46
Outline Rx of toxic nodular disease
Long term Rx of low doses 5-10mg CBZ/day
47
What is are the contraindications of radioactive iodine Rx?
1. Pregnancy 2.Eye disease in Graves' (two factors worsen exopthalmos - smoking and radioactive iodine)
48
What is are the contraindications of radioactive iodine Rx?
1. Pregnancy 2.Eye disease in Graves' (two factors worsen exopthalmos - smoking and radioactive iodine)
49
T/F ask for anti-thyroid Ab if suspecting Graves'
F - anti TSH receptor Ab
50
T/F check TFTs and adjust Rx within the 4-12 week interval
T - steady state of Rx is between 4-12 weeks
51
What is subclinical hypothyroidism?
d

Endocrinology (9 decks)

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