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ENDO > Thyroid Disorders > Flashcards

Thyroid Disorders Flashcards

1
Q

Where are t4/t3 produced?

A

All of T4 is produced in the thyroid
20% of t3 is secreted, the rest is from peripheral conversion of T4

T3 is active form, vital for growth and development

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2
Q

How is T4 converted to T3 and what happens when this doesnt work?

A

Monodeiodinisation be deiodinase enzymes (d1-3)

Deficiency in these enzymes causes high TSH, high T4 and low T3

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3
Q

What proteins bind thyroid hormones?

A

TBG, TBPA, albumin

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4
Q

What tests can you do for thyroid function?

A

-Serum TSH, freee t3 and free t4

Anti TPO Ab
Anti TSHR ab
USS thyroid to see if lesion is cystic/solid
Radioactive iodine uptake scan (i123)
CXR head and neck (retrosternal goitre, compression)
Serum thyroglobulin- useful in monitorring Ca

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5
Q

What would radionuclide uptake scans show in different causes?

A

Graves disease shows even uptake
Toxic nodular goitre shows patchy uptake
Thyroiditiss shows reduced uptake
cold nodules have a 20%chance of being malignant

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6
Q

What would TFTs show in sick euthyroid?

A

everything is low

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7
Q

Where do you see sick euthyroid syndrome?

A

Starvation states, severe illness requiring ITU, renal failure, cardiac/liver failure

Dont need to give thyroxine

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8
Q

What is struma ovarii?

A

Ovarian teratoma with hyper functioning thyroid tissue. No thyroid enlargement, decresed uptake on scintigraphy

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9
Q

How does TSH vary in the day?

A

trough at around 2, can be around 30% higher in darkness. Monitoring should always be done at the same time of day

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10
Q

How is TBG affected by other processes/drugs?

A

Increased in: Pregnancy, Pill/HRT, hepatitis

Decreased in: nephrotic syndrome, malnutrition, androgens, steroids, chronic liver disease, phenytoin, acromegaly

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11
Q

What would TFTs show in primary hyper thyroidism?

A

TSH-low, T4- Raised, T3- Raised

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12
Q

What would TFTs show in Subclinical hyperthyroidism?

A

TSH-low, T4- normal, T3- normal

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13
Q

What would TFTs show in secondary hyperthyroidism?

A

TSH -high, T4- Raised, T3- Raised

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14
Q

What would TFTs show in primary hypothyroidism?

A

TSH -high, T4- low, T3- low

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15
Q

What would TFTs show in Subclinical hypothyroidism

A

TSH -high, T4- normal, T3- normal

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16
Q

Most common causes of thyrotoxicosis?

A

Graves disease
Toxic nodular goitre
Thyroiditis

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17
Q

Less common causes of hyperthyroid?

A

tsh secreting adenoma, neonatal, ectopic thyroid tissue, amiodorone

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18
Q

What is the Ab in Graves?

A

Anti TSHRAB

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19
Q

Signs and symptoms of hyperthyroid?

A

CVS: tachycardia, AF, SOBOE, ankle swellin, cardiomyopathy

GI: diarrhoea, wt loss, incr appetite

Eyes/skin: sore, gritty, double vision, staring, pruritis

Neuro: tremor, proximal myopathy, anxiety

Other: ht intolerance, sweating, oligo/amennorhea, osteoporosis

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20
Q

what does the goitre feel like in graves?

A

diffusely enlarged, bossellation, soft and symmetrical. May be a bruit

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21
Q

Eye disease in graves?

A 
Lid lag/retraction
conjunctival oedema (chemosis)
periorbital puffiness
proptosis
ophthalmoplegia
grittiness
exposure keratitis
optic neuropathy

assymetrical often, unilateral in 15%

RAPD may show optic nerve compression so get help.

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22
Q

Skin symptoms in graves?

A

pretibial myxoedema
acropachy
vitiligo?

23
Q

Who should be screened for thyroid dysfunction?

A 
Those with AF
hyperlipidaemia
DM
T1DM and pregnant
amiodoron or lithium
downs, turners, addisons disease
24
Q

Associated conditions with graves?

A 
DM
Addisons
vitiligo
pernicious anaemia
alopecia areata
MG
coeliac
25
Q

in first trimester what effect on tfts?

A

use diffferent references as tsh can be low in some women

26
Q

Main risk factor in eye disease?

A

Smoking, 25-50%with graves will develop it. May not correlate with thyroid disease

27
Q

Treatment for thyroid eye disease?

A

mild: conservative: lift bed etc
Severe: steroids (methylpred) may help. Surgery may be needed if sight threatening

28
Q

Initial Management of Graves?

A

Refer all with overt signs to endo

Initially give a B Blocker to ameliorate symptoms

First line is thionamides: CBZ and PTU
compliance is better with CBZ and no chance of liver injury. most are euthyroid 8 weeks after. monitor every 6 weeks
Remission 40% at 18 mo

29
Q

S/E of thionamides?

A

liver injury: ptu
agranulocytosis
maculopapular rash
vasculitis

30
Q

When do you give PTU over CBZ?

A

pregnant, breast feeding, storm

31
Q

C/I to radio iodine?

A

Active orbitopathy, pregnant, breast feeding
stay away from preg and kids for 3 weeks

no babies for 6mo (4 if man)

32
Q

Risks of Radioiodine?

A

hypothyroidism, teratogenesis, optimal dose is unpredictable

33
Q

when is surgery considered?

A

failed/intolerant to medical therapy, obstructive symptoms, malignancy suspected

34
Q

complications of surgery?

A 
hypo
hypoPTH
recurrent laryngeal nerve damage
bleeding (v vascular thyroid in graves)
storm
35
Q

How can you prevent bleeding in thyroid surgery?

A

give lugols iodine, wolff chaikoff effect. large amounts of iodine reduces hormone

36
Q

S+S of storm?

A 
N+V
confusion
agitation
acute abdo, cvs collaps, heart failre, incr. temp
tachy
AF
37
Q

Precipitants of storm?

A

recent surgery/Radioiodine
infection
mi
trauma

38
Q

Management of storm?

A

iv saline

take bloods for TFT

Sedate if needed

Propanolol, digoxin if need to slow heart

carbimazole/ptu. lugols after 4 hours

steroids

abx for infection

39
Q

Causes of hypothyroidism?

A

1o: iatrogenic: amiodorone, lithium, surgery/R/I
AI: hashimotos, de quiervans, atrophic

2o: pituitary/hypothalamus tumours, trauma to either

40
Q

symptoms of hypothyroidism?

A

tired, lethargic, mood down, cold intolerant, wt gain, constipation, hoarse voise, decreased memory/cognition, dementia, cramps, weakness

41
Q

Signs of hypothyroidism?

A 
Bradycardic
B
Reflexes slow
Aataxia (cerebellar)
Dry hair/skin
Yawingin (tired)
Cold intolerance
Ascites +non pitting oedema
Round face
Defeated demeanor
Immobile, ileus
CCF
42
Q

Causes of AI hypothyroidism?

A

primary atrophic: lymphcytic infiltration, no goitre as atrophy
hashimotos: women 60-70, auto antibody titres high

43
Q

problems in pregnancy with hypothyroidism?

A

eclampsia, anaemia, prematurity, low BW, still birth

44
Q

Treatment for hypothyroidism?

A

Levothyroxine, 50-100ug

review at 12 weeks, adjust 6 weekly by clinical state but not to suppress TSH

45
Q

Changes to treatment in elderly with hypothyroidism?

A

reduce dose to 25, increase carefully as may precipitate angina/mi

46
Q

why is amiodorone a bugger in thyroids?

A

iodine rich, 2% get problems. hypo can be caused by toxic iodine excess, thyrotoxicosis from destructive thyroiditis that causes release. half like 80 days so problems persist

47
Q

Myxoedema Coma signs

A 
looks hypop
old
hypothermia
low BG
bradycardia
coma 
seizures

may have had recent iodine/surgery. cyanotic, low bp and HF

48
Q

management of Myxoedema Coma?

A

bloods oxygen if cyanosed

correct hypoglycaemia

T£ IV slowly

hydrocortisone

iv saline

abx if infection

49
Q

what can affect absorption of LT4?

A

Gi conditions: ibd, coeliac, gastritis

milk and coffee

50
Q

Important flags for thyroid cancer?

A

solitary/multinodular lump, clinically euthyroid

FH
LN swellin
Hoarseness/change in voice
Difficulty swallowing
stridor
51
Q

RF for thyroid cancer?

A

radiation exposure, neck irradiation

52
Q

types of thyroid cancer?

A

paipillary
follicular
anaplastic
medullary

53
Q

why give steroids in thyrotoxic storm?

A

prevents peripheral conversion of t4 to t3

ENDO (6 decks)

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