Week 3 Flashcards
(189 cards)
1
Q
What is the functional unit of thyroid gland
A
Follicle
2
Q
Describe the structure of a thyroid follicle
A
Follicular cells arranged into a sphere shape.
Colloid in the centre lumen
Parafollicular cells (C cell) between follicles
Highly vascularised
3
Q
What is colloid rich of
A
Thyroglobulin
4
Q
What type of epithelial cells are follicular cells
A
Cuboidal cells
5
Q
Describe the Hypothalamus-pituitary-thyroid axis
A
- Paraventricular nucleus of hypothalamus stimulated, releases TRH into hypophyseal portal system
- TRH travels to the anterior pituitary gland which stimulates the release of TSH
- TSH travels to thyroid gland through bloodstream and stimulates the synthesis and release of T3 and T4
- T3 and T4 hormones exhibit negative feedback which inhibits the release of TRH and TSH
6
Q
Which part of the thyroid gland is covering the second tracheal ring
A
Isthmus
7
Q
What structures are visible at the posterior aspect of the thyroid gland
A
Parathyroid glands
8
Q
What would the TSH/TRH levels be in a hyperactive thyroid gland
A
Low due to high levels of T3 and T4
9
Q
What substance is required for the synthesis of thyroid hormones
A
Iodine
10
Q
Describe the movement of the thyroid gland from back of the tongue to its current position in an embryo
A
- Begins at 4th week of embryogenesis. Midline thickening at the back of the tongue
- Moves downwards, eventually reaching in front of the tracheal rings
- becomes in contact with the parathyroid glands which had developed in the area
- The residue of the thyroid gland at the back of the tongue becomes foramen caecum
11
Q
Describe the development of the thyroid gland
A
- Endodermal thickening
- migrates downwards to form thyroglossal duct
- the 2 lobes of thyroid gland and the isthmus develop from the thyroglossal duct
- Thyroglossal duct is degraded in most people but not all
- the remnant of thyroglossal duct = pyramidal lobe
12
Q
When will primitive follicles of the thyroid gland become visible and start trapping iodine
A
By 12 weeks
13
Q
Which condition are people at risk of due to thyroglossal duct not disintegrating
A
Thyroglossal cysts
14
Q
Where are thyroglossal cysts mostly found
A
Near the hyoid bone
15
Q
Where to palpate the thyroid gland
A
- starting from the chin and moving downwards, palpate the midline
- palpate the first hard structure: thyroid cartilage
- palpate the second hard structure: cricoid cartilage
- move downwards to palpate the first.2 tracheal rings
- the isthmus overlies the second tracheal ring
- go laterally and medially around and upwards
16
Q
Nerve supply of the thyroid gland
A
Sympathetic nerve supply: superior, medial, inferior sympathetic trunk
Parasympathetic nerve supply: Vagus nerve
17
Q
Arterial supply of the thyroid gland
A
Superior and inferior thyroid arteries
18
Q
Venous drainage of the thyroid gland
A
Superior and middle thyroid veins drain into the internal jugular vein
Inferior thyroid vein drains into the brachiocephalic vein
19
Q
Which ligament is the primary fixation of the thyroid gland to its surrounding structures
A
Posterior suspensory ligament (Berry ligament)
20
Q
What nerve is behind the posterior suspensory ligament
A
Recurrent laryngeal nerve
21
Q
What structures are innervated by the recurrent laryngeal nerve
A
All Intrinsic muscles of the larynx except the cricothyroid muscles
22
Q
Name the intrinsic muscles of the larynx innervated by the RLN
A
Thyroarytenoid muscle
Posterior cricoarytenoid muscle
Lateral cricoarytenoid muscle
Transverse and oblique cricoarytenoid muscles
23
Q
Which nerve innervates the cricothyroid muscle
A
Superior laryngeal nerve - a branch of vagus nerve
24
Q
Function of the cricothyroid muscle
A
Stretches and tenses the vocal cords to make forceful voice
Changes tone of voice
25
Function of the thyroarytenoid muscle
Relax the vocal cords to make softer voice
26
Function of the posterior cricoarytenoid muscle
Sole muscle that abducts the vocal cords hence opening the rima glottidis
27
Function of the lateral cricoarytenoid muscle
Major muscle that adducts the vocal cords hence narrowing the rima glottides
28
Function of the transverse and oblique cricoarytenoid muscles
Adducts the arytenoid cartilage to narrow the laryngeal inlet
29
Consequence of damage to recurrent laryngeal nerve after thyroidectomy
Hoarseness of voice
Loss of voice
Change in pitch
Dyspnea
Dysphagia
30
Why can dyspnea occur due to RLN damage
Because it can cause the paralysis of posterior cricoarytenoid muscle which is the only muscle that can abduct the vocal cords to open the rima glottidis
31
What is thyroglobulin rich of
tyrosine amino acids
32
Steps of thyroid hormone synthesis
1. Thyroglobulin synthesised by follicular cells
2. uptake and concentration of iodide into the colloid
3. Iodide moves into follicular cells
4. Oxidation of 2 iodide ions into iodine in the follicular cells
5. Iodine passed into the colloid
6. iodination of thyroglobulin
33
Describe the iodination of thyroglobulin to form T3 and T4
1. Peroxidase enzyme in colloid links iodine to tyrosine amino acids in thyroglobulin
2. Forms 2 intermediaries: tyrosine + 1 iodine and tyrosine + 2 iodine
T3 is formed by those 2 intermediaries joining together
T4 is formed by linkage of 2 tyrosine + 2 iodine
34
Where is thyroglobulin stored in till it is needed
Colloid
35
Which thyroid hormone is more potent
T3
36
Which drugs are used to treat hyperthyroidism
Carbimazole
Propylthiouracil
37
Mechanism of action of carbimazole
Inhibits thyroid peroxidase enzymes which are required for iodination of thyroglobulin
38
Which thyroid hormone makes up 90% of the thyroid hormones secreted
T4
39
Which thyroid hormone is biologically active
T3
40
Why does T4 need to be converted to T3
To become metabolically active
41
Which organs are responsible for the conversion of T4 into T3
Liver and kidney
42
How are thyroid hormones transported to target cells
Bound to serum proteins
43
What are the serum proteins that thyroid hormones can bind to
Thyroxine binding globulin
TTR (transthyretine)
Thyroxine binding pre-albumin
Albumin
44
Are most thyroid hormones unbound or bound to serum proteins
Bound to serum proteins
Only 0.015% of total T4 are free T4
Only 0.33% of total T3 are free T3
45
Bound / unbound thyroid hormones can enter the cells
Unbound
46
Why does T3 have a more rapid onset and offset of actions
Because it is bound less strongly by TBG (thyroxine binding globulin) than T4 and it is not bound significantly by TTR (transthyretin; transports thyroxine and vitamin A aka retinol)
47
Which, unbound or bound thyroid hormone concentration, correlates more closely to the metabolic state
Unbound
48
Effects of thyroid hormones
Increase metabolic rate
Increase in gluconeogenesis and glycogenolysis
Increase in lipolysis
Increase in respiratory rate and heart rate
Growth and development
49
Why does thyroid hormones cause an increase in gluconeogenesis and glycogenolysis
To increase the amount of glucose available for respiration; since increase in metabolic rate = increase in respiration = increase in glucose substrate needed
50
Why does thyroid hormone cause an increase in respiratory and heart rate
To meet the increase in demand of O2 due to the increase in metabolic rate
51
Thyroid hormones metabolic effects
Increases metabolic rate and thermogenesis
Increase blood glucose
Increase lipolysis
Increase FFA oxidation
Increase in protein synthesis
52
Why do thyroid hormones have effects on growth and development
Because the GHRH (growth hormone releasing hormone) and GH requires presence of thyroid hormone for activity
53
What can occur if a child has hypothyroidism
Growth retardation
54
What happens to the development of CNS in the child if the mother has hypothyroidism
The baby can have slower congnitive and intellectual functions
55
What enzymes are responsible in degrading t3 and T4
D1, D2, D3
56
Where is D3 found
Fetal tissue
placenta
Brain except pituitary
57
Which thyroid degrading enzyme is found in the pituitary
D2
58
Majority of T3 and T4 are degraded by which enzyme
D3
59
Causes of hypothyroidism
Primary thyroid gland failure
Secondary to TRH or TSH deficiency
Lack of iodine in diet
60
What is goitre
Enlargement of the thyroid
61
Symptoms and signs of hypothyroidism
Weight gain (due to decrease in BMR)
Slow heart rate
Fatigue
Cold intolerance
Goitre
Constipation
Dry hair
Brittle nails
Vitiligo
62
Mneumonic for symptoms of hypothyroidism (MOM'S SO TIRED)
Memory loss
Obesity (weight gain)
Menorrhagia
Slowness mentally and physically
Skin and hair dryness
Onset is gradual
Tiredness
Intolerance to cold
Raised BP
Enlarged thyroid gland
Depression
63
What can occur in babies due to hypothyroidism
Dwarfism
Intellectual defects
Slow growth and development (reach milestones later or not at all)
64
What is Grave's disease
Autoimmune disease that causes hyperthyroidism
65
Symptoms and signs of hyperthyroidism
Sweating
Bulging eyes (proptosis)
Goitre
Weight loss
Insomnia
increased nervousness and excessively emotional
Fast heart rate
Heat intolerance
66
What would the thyroid hormones level be in primary hypothyroidism
Low T3/T4
High TSH
67
What would the thyroid hormones level be in secondary hypothyroidism
Low T3/T4
Low/normal TSH
68
Why is TSH level called "inappropriately normal" in secondary hypothyroidism
In secondary hypothyroidism, the low T3/T4 level should cause a high TSH level but because the secondary hypothyroidism is caused by a defect in the pituitary gland, TSH level is low/normal
69
What will the thyroid hormone level in secondary hyperthyroidism be
High T3/T4
High or normal TSH
70
Hypothyroidism is more common in which type of people
Females
White populations
People in areas with high iodine intake
71
What is secondary hypothyroidism
Hypothyroidism not due to thyroid dysfunction
72
Goitrous causes of primary hypothyroidism
Hashimoto's thyroiditis
iodine deficiency
Amiodarone induced hypothyroidism
73
Non-goitrous causes of primary hypothyroidism
Atrophic thyroiditis
Congenital hypothyroidism
Post partum thyroiditis
74
What is Hashimoto's thyroiditis
it is an autoimmune destruction of thyroid gland causing reduction in thyroid hormone production
75
Which group of people are more at risk of Hashimoto's thyroiditis
Family history of autoimmune conditions (e.g. T1 diabetics)
Family history of autoimmune thyroiditis (grave's / Hashimoto's)
Turner's and Down syndrome
Males
76
What are the secondary causes of hypothyroidism
Malignancies
Infections
Trauma
Surgery
Congenital
Radiotherapy
77
What is the most common antibody present in Hashimoto's thyroiditis
Anti- thyroid peroxidase antibodies (anti-TPO)
78
Can you diagnose Hashimoto's thyroiditis just based on elevated anti-TPO
No, because anti-TPO is not specific to Hashimoto's. It can be present in Grave's disease (hyperthyroidism) and in healthy people too
79
What test should be done to diagnose hypothyroidism/hyperthyroidism and how do you differentiate whether it is primary or secondary
TSH and T3/T4 level
Autoantibodies not required because these are not specific
Primary hypothyroidism: T3/T4 low TSH high
Secondary hypothyroidism: T3/T4 low TSH low/normal
Primary hyperthyroidism: T3/T4 high TSH low
Secondary hyperthyroidism: T3/T4 high TSH high/normal
80
Amiodarone most commonly causes hypothyroidism or hyperthyroidism
Hypothyroidism
81
How does amiodarone cause hypothyroidism
Wolff Chaikoff effect; Amiodarone contains iodide
Excess iodine blocks the iodination of thyroglobulin causing a reduction in levels of thyroid hormone
82
What is atrophic thyroiditis
Non-goitrous cause of primary hypothyroiditis; antibody attack causing the thyroid gland to be severely shrunken
83
What causes congenital hypothyroidism
Dyshormonogenesis (defect in synthesis of thyroid hormone)
Abnormal gland development
84
What is postpartum thyroiditis
Self limiting inflammation in women after giving birth. Typically progresses from hyperthyroidism into hypothyroidism
85
Who is most at risk of postpartum thyroiditis
Pregnant women with T1 diabetes
86
What respiratory symptoms can be seen in hypothyroidism
Deep hoarse voice
Macroglossia (abnormally large tongue)
Obstructive sleep apnoea (goitre blocking airway)
87
What gynaecological symptoms can be seen in hypothyroidism
Menorrhagia - heavy menstrual bleeding
amenorrhea - absence of periods
oligomenorrhea - infrequent periods
88
Hashimoto's thyroiditis is Th1/Th2 predominant
Th1
89
What cardiac symptoms may occur in hypothyroidism
Bradycardia
Cardiac dilatation
Pericardial effusion
Heart failure
90
Management of hypothyroidism
Gradual restoration of thyroid hormones using Levothyroxine
91
What is levothyroxine
Synthetic version of T4
92
Why is it important to restore the thyroid hormone level gradually instead of rapidly
Gradual restoration prevent cardiac arrhythmias
93
Is levothyroxine safe during pregnancy
Yes
94
Should you change the dosage of levothyroxine during pregnancy
Yes, double the dose during pregnancy
95
What is subclinical hypothyroidism
When the patient has elevated TSH but normal T3/T4
96
Do you need to treat subclinical hypothyroidism
No unless the patient becomes symptomatic and develop goitre / T3 and T4 level dropped
Otherwise, keep routinely check their TSH and T3/T4 level
97
What is myxoedema
Clinical emergency due to severe hypothyroidism
98
Which group of people are at risk of myxoedema
Elderly
Long standing, untreated hypothyroidism
99
Signs of myxoedema
Bradycardia
Abnormal ECG
Type 2 resp failure
Hypothermia
Adrenal failure
100
What abnormalities on ECG can be seen in myxoedema
Heart block
Prolonged QT
T wave inversion
101
Management of myxoedema
ABCDE
Passively rewarm the patient
IV levothyroxine
IV hydrocortisone (if there is adrenal failure)
102
What is thyrotoxicosis
Clinical state arising when the tissues are exposed to excess thyroid hormones
103
What is hyperthyroidism
Overactivity of thyroid gland leading to excess thyroid hormones
104
Is hyperthyroidism the only cause of thyrotoxicosis
No, thyrotoxicosis can also be due to e.g. ingestion of excess thyroid hormones
105
Causes of primary hyperthyroidism
Grave's disease
Hashitoxicosis
Toxic multi nodular goitre
Toxic solitary nodule
De Quervain's thyroiditis
106
What is Grave's disease
Autoimmune condition with TSH receptor antibodies acting like TSH causing excessive stimulation of the thyroid gland
107
What can happen to the thyroid hormone levels of patients with Grave's disease over time
Can switch from hyperthyroidism to hypothyroidism
108
Risk factors of Grave's disease
Young
Family history of autoimmune disease
PMH of autoimmune disease
Smoking
109
What is toxic multi nodular goitre
Multiple autonomous nodules develop that are capable of producing and secreting thyroid hormones
110
What is toxic solitary goitre
Single autonomous adenoma develop and can produce + release thyroid hormones
111
What is Hashitoxicosis
Early stage of Hashimoto's thyroiditis
In early stage of Hashimoto's thyroiditis, there can be a period of hyperthyroidism then progresses into hypothyroidism
112
Causes of secondary hyperthyroidism
Postpartum thyroiditis
Amiodarone induced thyroiditis
Overtreatment with levothyroxine
Struma ovarii
Pituitary adenoma
Lithium
113
What is De Quervain's thyroiditis
A self limiting condition that causes the thyroid gland to swell rapidly and causes hyperthyroidism
114
What may eventually occur to the thyroid hormone levels in patients with De Quervain's thyroiditis over time
Hyperthyroidism -> hypothyroidism
Due to depletion of colloid and reduction in TSH production
115
What is amiodarone induced thyrotoxicosis type 1
Jod Basedow phenomenon which states that excess iodine intake causes excess thyroid hormone synthesis
116
What is amiodarone induced thyrotoxicosis type 2
Destructive thyroiditis due to direct toxic effect on follicular cells with resultant release of thyroid hormone
117
Which conditions can lead to both hyperthyroidism and hypothyroidism
Hashimoto's (hashitoxicosis)
Grave's (progresses into hypothyroridism)
Postpartum thyroiditis
Amiodarone induced
De Quervain's thyroiditis (progresses into hypothyroiditis)
118
What is struma ovarii
Thyroid hormone released from ectopic thyroid tissue related to ovarian teratoma and dermoid tumours
119
Except from thyroid hormone levels, what other labratory test findings can present in Grave's disease
Hypercalcaemia
Increase in alkaline phosphatase
Leucopenia (decrease in WCC)
TSH receptor antibody
120
Why is an elevated level of TSH receptor antibody a good indication for Grave's disease
Because it is present in 90% of patients with Grave's. Although it is can also be present in Hashimoto's disease, it is only present in 10-20% of patients
121
Which cardiac arrhythmia can be caused by thyrotoxicosis
Atrial fibrillation
122
What are the neurological signs of thyrotoxicosis
Anxiety
Nervousness
Sleep disturbance
Tremor
Sweating
123
What symptoms are specific to Grave's disease
Pretibial myxoedema
Thyroid acropachy
Thyroid bruit
Grave's opthalmopathy
124
What is thyroid bruit
Continuous sound heard over thyroid mass, only heard in Grave's
125
What causes thyroid bruit
Enlarged thyroid gland causes proliferation of blood supply and the hypervascularity of thyroid causes the bruit
126
What is thyroid acropachy
Periostitis, nail clubbing, swelling of the fingers / toes
127
What is pretibial myxoedema
Specific sign of Grave's disease; thick scaly skin and swelling of the leg due to build up of glycosaminoglycans within the dermis
128
What are the eye abnormalities seen in Grave's disease
Proptosis (bulging of eyes)
Intolerance of bright lights
Excessive dryness
Swelling
Sight loss
129
What are the signs that indicate moderate to severe grave's ophthamolpathy
Diplopia
Significant lid retraction
Significant soft tissue involvement
Exopthalamos > 3mm
Optic neuropathy
Corneal breakdown
130
What is diplopia
Double vision
131
Management of mild Grave's opthalmopathy
Topical lubricants
Advise to elevate head when sleeping / wear sunglasses
132
Management of severe Grave's opthalmopathy
Steroids
Surgery
Radiotherapy
133
Management of hyperthyroidism
1. Carbimazole / propylthiouracil
+ Beta blockers for symptomatic relief
2. Radioiodine therapy
3. Surgery
134
Which beta blocker is used in hyperthyroidism
Propanolol
135
Contraindications for beta blockers
Patients with asthma because beta blockers can cause bronchospasm
136
Which drug should be used for hyperthyroidism if beta blockers are contraindicated
Calcium channel blocker (dilitiazem)
137
Why are beta blockers used for symptomatic relief in hyperthyroidism
Because they can reduce the activity of the sympathetic nervous system hence reduce symptoms caused by it until thioamides take effect
138
Examples of thioamides
Carbimezole
Propylthiouracil
139
How do thioamides treat hyperthyroidism
By blocking peroxidase to reduce thyroid synthesis
140
Contraindication for carbimazole
Pregnant / planning to become pregnant
Deranged LFT
141
Why is carbimazole contraindicated in pregnant women
Because it is associated with congenital malformations
142
What tests should be done before giving thioamides
FBC and LFT (to check transaminase levels)
Pregnancy test
143
Severe side effect of thioamides
Agranulocytosis - absence / reduction of granulocytes especially neutrophils, puts patients at risk of severe infection and sepsis
144
Indications for radioiodine therapy
Toxic multi nodular goitre
Toxic solitary goitre
145
Difference between nodular thyroid disease and Grave's disease
Nodular thyroid disease - absent TSH receptor antibodies
Nodular thyroid disease causes asymmetrical goitre whereas Grave's disease causes smooth goitre
Nodular thyroid disease more common in older patients whereas Grave's disease more common in younger patients
146
Contraindications for radio iodine therapy
Pregnant women / breastfeeding
Those with active thyroid eye disease
147
Side effects of radio iodine therapy
Exacerbate thyroid eye disease
Hypothyroidism
148
When is surgery used for hyperthyroidism
Other management contraindicated
Recurrent hyperthyroidism
Goitre obstructing other structures
149
Complications of thyroidectomy / hemithyroidectomy
RLN damage
Hypothyroidism
Hypocalcaemia
150
How may thyroidectomy lead to hypocalcaemia
Damage to parathyroid glands which produce parathyroid hormones
151
Types of thyroid cancer
Papillary thyroid cancer
Follicular thyroid cancer
Anaplastic thyroid cancer
Medullary thyroid cancer
152
What is medullary thyroid cancer
Thyroid cancer derived from parafollicular C cell
Associated with MEN 2
153
Hormone levels in medullary thyroid cancer
Calcitonin raised
Serum Ca2+ reduced (hypocalcaemia)
154
Function of calcitonin
Opposes action of PTH, reduces Ca2+ level
155
Which thyroid cancer is the most common
Papillary
156
Which thyroid cancer has the worst prognosis
Anaplastic, it is the most aggressive form
157
Difference between papillary thyroid cancer and follicular thyroid cancer
Papillary cancer is associated with Hashimoto's thyroiditis whereas follicular cancer is not
Papillary cancer spreads via lymphatics and rarely by blood whereas follicular cancer spreads via blood and rarely lymphatics
Papillary cancer is not related to iodine whereas follicular cancer is related to iodine deficiency
158
Differentiated thyroid cancer is driven by which hormone
driven by TSH hormone
159
Risk factors of thyroid cancer
Radiation exposure (esp during childhood)
Female
Family history
160
What are the symptoms and signs of thyroid cancer
Palpable thyroid nodules
Cervical lymphadenopathy
Stridor
Hoarseness / change in voice
161
What is stridor
Harsh, high pitched noise heard on inspiration due to upper airway obstruction
Often described as "barking" sound
162
Because most palpable nodules are benign, what other clinical signs are more suggestive of malignancies
Nodule rapidly increasing in size
Vocal cord palsy
Lesion > 4 cm
History of neck or head irradiation
Male (although thyroid cancer is more common in females, males have a worse survival and more aggressive disease)
163
Thyroid cancer is more common in female / male
Female
164
Which thyroid cancer is associated with hashimoto's thyroiditis
Papillary
165
What investigations should be done if you suspect thyroid cancer
TFT - TSH / T4/ T3
Fine needle aspiration
Fine needle aspiration cytology
Patient specific investigations i.e. if they have certain signs
166
What patient specific investigations can be done if you suspect thyroid cancer
Present with vocal palsy - laryngoscopy
Present with suspicious lymph nodes - CT/MRI scan
167
What is AMES
pre-operative risk stratification depending on
Age
Metastases
Extent of primary tumour
Size of primary tumour
168
Surgical options for thyroid disease
Lobectomy
Hemithyroidectomy
Total thyroidectomy
169
Indications of hemithyroidectomy / total thyroidecomy
High AMES risk
Lymph involvement
Distant metastases
Extra-thyroidal invasion
170
Indications of lobectomy
Papillary microcarcinoma <1cm diameter
low AMES risk
minimally invasive follicular carcinoma
171
Complications of thyroid surgery
RLN damage
hypothyroidism
hypoparathyroidism
172
What happens as a result of hypoparathyroidism
Hypocalcaemia
because parathyroid glands produce parathyroid hormone to increase blood calcium levels so damage to those glands can lead to hypocalcaemia
173
What can hypocalcaemia lead to
Muscle spasms
Muscle weakness
Seizures
QT prolongation
Predisposition to ventricular arrhythmias
174
Why do you need to monitor calcium levels closely after thyroid surgeries
To check for hypocalcaemia due to parathyroid gland damages
175
What should you do if calcium levels are too low after thyroid surgeries
Start calcium replacement / IV calcium
Prevent overtreating to prevent hypercalcaemia
176
What ECG changes can happen due to hypercalcaemia
shortened QT interval
177
Which hormone acts against parathyroid hormones to decrease blood calcium level
calcitonin produced by thyroid gland
178
Post op care for patients after total thyroidectomy / hemi thyroidectomy
Surpress TSH level (if papillary / follicular)
Levothyroxine therapy
Whole body iodine scan
Radioiodine ablation (if there are remnants
179
What should be monitored if the patient had surgery due to medullary thyroid cancer
Calcitonin and calcium level
180
What should be done before taking the whole body iodine scan
Increase TSH level to above 20 by injecting rhTSH
181
Why does TSH level need to be increased before taking whole body iodine scan
Because differentiated thyroid cancer (papillary, follicular) is TSH driven hence TSH will stimulate the remaining cancer cells to take up iodine. This allows the cancer cells to light up on the scan
182
What is the use of radio iodine ablation
To destroy the remnant thyroid tissue to prevent recurrence of cancer / increase chance of long term remission
183
What safety cautions should the patient be aware of after they receive radio iodine ablation
Cannot mother / father a child
Avoid pregnant women / child
Avoid close contact with other people
Till safe
184
Why should TSH level be suppressed after thyroid cancer surgery
To prevent recurrence of the cancer
185
How do you suppress TSH level after thyroid cancer surgery
Put the patient on levothyroxine to suppress TSH
186
What can happen if the patient overdoses on levothyroxine
Heart failure
Atrial fibrillation
Osteoporosis
187
What can be measured to assess for residual tissue / recurrent disease for those that got total thyroidectomy +/- radioiodine ablation
Thyroglobulin
188
Mneumonic for symptoms of hypothyroidism (MOM'S SO TIRED)
Memory loss
Obesity (weight gain)
Menorrhagia
Slowness mentally and physically
Skin and hair dryness
Onset is gradual
Tiredness
Intolerance to cold
Raised BP
Enlarged thyroid gland
Depression
189
What is sick euthyroid syndrome
Hypothyroidism that occurs in any systemic illnesses but tend to not have any symptoms
