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Phase 2B > Thyroid History > Flashcards

Thyroid History Flashcards

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1
Q

Describe what would happen in hyperthyroidism to change in body weight

A

Decrease despite increased appetite (although 10% will gain weight)

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1
Q

Describe what would happen hypothyroidism to change in body weight

A

Increase

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2
Q

Describe what would happen in hyperthyroidism to change in appetite

A

Increase

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3
Q

Describe what would happen in hypothyroidism to change in appetite

A

Decrease

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4
Q

Describe what would happen in hyperthyroidism to change in voice

A

No change

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5
Q

Describe what would happen in hypothyroidism to change in voice

A

Hoarseness

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6
Q

Describe what would happen in hyperthyroidism to change in energy level

A

Can increase or decrease
Muscle weakness

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7
Q

Describe what would happen in hypothyroidism to change in energy level

A

Decrease
Somnolent
Slower movements and muscle weakness

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8
Q

Define somnolent

A

Tired and ready to fall asleep

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9
Q

Describe what hyperthyroidism to change in mood

A

Anxious
Irritable
Emotionally liable

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10
Q

Describe what hypothyroidism to change in mood

A

Lethargy
Depression

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11
Q

What would happen in hyperthyroidism to change in concentration

A

Decrease

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12
Q

What would happen in hypothyroidism to change in concentration

A

Decrease

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13
Q

What would happen in hyperthyroidism to change in heat tolerance

A

Sensitive to heat

Prefers a cool environment, wears fewer clothes

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14
Q

What would happen in hypothyroidism to change in heat tolerance

A

Sensitive to cold

Prefers a warm environment, wears extra clothes

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15
Q

What would happen in hyperthyroidism to change in skin, nails and hair

A

Increased sweating
Fine hair and hair loss
Clubbing (thyroid acropachy)
Onycholysis (separation of the nail from the nailbed)

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16
Q

What would happen in hypothyroidism to change in skin, nails and hair

A

Dry flaky skin
Coarse thinning hair
Brittle nails

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17
Q

What would happen in hyperthyroidism to change in heart rate/rhythm

A

Tachycardia
Palpitations
Atrial fibrillation

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18
Q

What would happen in hypothyroidism to change in heart rate/rhythm

A

Bradycardia

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19
Q

What would happen to change in menstrual cycle in hyperthyroidism

A

Infrequent menses
Fertility problems

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20
Q

What would happen in change in menstrual cycle in hypothyroidism

A

Heavy, prolonged or irregular menses
fertility problems and increased risk of miscarriage

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21
Q

Define menses

A

Menstruation

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22
Q

What are 3 specific areas to cover in a thyroid history

A

Drug history and allergies
Social history
Family history

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23
Q

Why is drug history important in thyroid history

A

Specifically enquire about thyroxine, lithium, amiodarone and glucocorticoids

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24
Why is social history important in thyroid history
Smoking, alcohol, diet (sufficient iodine), and effect of activities of daily living
25
Name 5 examples of glucocorticoids
Beclomethasone Dexamethasone Hydrocortisone Prednisolone Methylprednisolone
26
Why is family history important in a thyroid history
Thyroid disease can be familial
27
Describe the role of T3 if it is high
Increases metabolism = weight decreases + potentiates effects of catecholamines e.g. adrenaline resulting in excessive sympathetic output (tremor, tachycardia, anxiety)
28
Describe the role of T3 if it is low
Results in weight gain, low mood, constipation, poor memory, hyporeflexia
29
What are you looking for when checking general appearance in a thyroid examination
Build Inappropriate clothing Restlessness Confusion Quality of skin and hair
30
Describe thyroid acropachy
Similar appearance to finger clubbing - caused by periosteal phalangeal bone overgrowth secondary to Grave's disease
31
Describe onycholysis
Painless detachment of the nail from the nail bed associated with hyperthyroidism
31
What is thyroid acropachy associated with
Secondary to graves disease (similar appearance to finger clubbing but caused by periosteal phalangeal bone overgrowth)
32
In thyroid condition when would onycholysis be seen
Hyperthyroidism
33
In which thyroid condition would palmar erythema be seen
Hyperthyroidism
34
Describe palmar erythema
Reddening of the palms associated with hyperthyroidism, chronic liver disease and pregnancy
35
What hand signs are you looking for
Palmar erythema Clubbing (thyroid acropachy) Brittle nails Onycholysis
36
In peripheral tremor what is it a feature of
Hyperthyroidism Reflecting the sympathetic nervous system overactivity
37
How long much an irregular rhythm be calculated for
60 seconds
38
What is a healthy adult pulse
60-100 bpm
39
What is bradycardia and its causes
<60bpm Healthy athletic individuals, hypothyroidism, atrioventricular block, medications, sick sinus syndrome
40
What would be seen in a heart for hypothyroidism
< 60 bpm (bradycardia)
41
Describe tachycardia and its causes
> 100bpm Hyperthyroidism, anxiety, supraventricular tachycardia, hypovolaemia
42
What thyroid condition is atrial fibrillation associated with
Atrial fibrillation
43
What is dry skin associated with
Hypothyroidism
44
What is excessive sweating associated with
Hyperthyroidism
45
What is the absence of the outer 3rd of the eyebrows associated with
Hypothyroidism (rare sign)
46
Describe exophthalmos
Proptosis (forward displacement of the eye) Grave's disease
47
What bilateral eye feature is seen in Graves disease
Exophthalmos
48
Why does exophthalmos occur
Bulging of the eye anteriorly out of the orbit Due to oedema and lymphocytic infiltration of orbital fat, connective tissue and extraocular muscles
49
Describe lid retraction
Inspect eyes from the front and note if sclera is visible between upper lid margin and the corneal limbus
50
What thyroid condition is lid retraction seen in
All hyperthyroidism Is most common ocular sign of Graves' disease
51
Describe why lid retraction occurs
Occur due to the sympathetic hyperactivity causing excessive contraction of the superior tarsal and levator palpebrae superioris muscles
52
How do you inspect for lid lag
Ask patient to look down Delayed downward movement of the eyelids on downgaze indicated lid lag sign
53
What is lid lag a sign of
Hyperthyroidism
54
What signs of inflammation are seen in thyroid disease
Due to lid retraction and exophthalmos, the eye is more prone to dryness and development of conjunctival oedema (chemosis) conjunctivitis Corneal ulceration (severe cases)
55
Define lid lag
Refers to a delay in the descent of the upper eyelid in relation to the eyelid when looking down
56
If a lump in the neck moves when water is swallowed what does this suggest
Thyroid mass
57
Describe the movement of thyroid gland masses (e.g. goitre) and thyroglossal cysts with swallowing
Typically move upwards
58
Describe the movement of lymph nodes with swallowing
Typically move very little
59
Describe the movement of n invasive thyroid malignancy with swallowing
May not move with swallowing if tethered to surrounding tissue
60
Describe the movement of thyroglossal cysts when a patient protrude their toungue
Move upwards
61
Why do you percuss in a thyroid examination
Percuss upper sternum for retrosternal extension of the goitre
62
Why do you auscultate in a thyroid examination
For a bruit (each lobe) using bell of stethoscope
63
What do bruits of the thyroid suggest
Indicates increased vascularity (typically occurs in Graves disease)
64
What condition is thyroid bruits secondary to
Graves disease
65
Describe proximal myopathy
(proximal weakness) Potential complication of multinodular goitre and Graves' disease Develop wasting of their proximal musculature causing difficulties in tasks e.g. standing from a sitting position
66
What conditions is proximal myopathy a potential complication of
Multinodular goitre and Graves disease
67
What is hyporeflexia associated with
Hypothyroidism
68
What is checking reflexes associated with
Hypothyroidism
69
Describe pretibial myxoedema
Form of diffuse mucinosis in which there is an accumulation of excess glycosaminoglycans in dermis and subcutis of the skin
70
How does pretibial myxoedema present
Waxy, discoloured induration of the skin on the anterior aspect of the lower legs (pre-tibial region)
71
What is pretibial myxoedema a rare complication
Graves' disease
72
Give an example summary of a thyroid examination
“Today I examined Mr Smith, a 32-year-old male. On general inspection, the patient appeared hyperactive at rest, with a peripheral tremor. There were no objects or medical equipment around the bed of relevance.” “The patient was tachycardic at 105 bpm with a regular pulse. Inspection of the neck was unremarkable but palpation revealed a mass in the thyroid region that contained multiple nodules. The mass moved upwards on swallowing but was stationary during tongue protrusion. There was no palpable lymphadenopathy but retrosternal dullness was present to the level of the manubrium. Auscultation of the thyroid gland did not reveal any bruits, reflexes were normal and there was no evidence of pretibial myxoedema or proximal myopathy.” “In summary, these findings are consistent with a toxic multinodular goitre.” “For completeness, I would like to perform the following further assessments and investigations.”
73
What further investigations can be done after a thyroid examination
Thyroid function tests - TSH, T3, T4 ECG (if irregular pulse) Ultrasound scan of neck

Phase 2B (15 decks)

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