Week 3 (2) Flashcards
(123 cards)
1
Q
What is the commonest cause of hypo/hyper thyroidism?
A
Autoimmune thyroid disease
2
Q
What has low TSH, high T4 and T3?
A
Hyperthyroidism
3
Q
What has high TSH, and low T4/T3?
A
Hypothyroidism
4
Q
What condition has high TSH and high T4/3?
A
TSH oma (rare - pituitary disease secondary hyper/hypothyroidism)
5
Q
What condition has low TSH and T4/3?
A
Pituitary gland failure
6
Q
What refers to either severe hypothyroidism e.g. myxoedema coma or to accumulation of hydrophilic mucopolysaccharides in the ground substance of the dermis and other tissues-doughly induration of the skin classical seen in the shins = pretibial myxoedema which is seen in graves disease?
A
Myxoedema
7
Q
Give two goitrous causes of primary hypothyroidism?
A
- Chronic thyroiditis - hashimotos thyroiditis (autoimmune)
2. Iodine deficiency
8
Q
Name a drug which causes iodine deficiency?
A
Amiodarone, lithium, IL-2
9
Q
Give four non-goitrous causes of primary hypothyroidism?
A
- Congenital developmental defect
- Atrophic thyroiditis
- Post-ablative (radioiodine)
- Postradiation
10
Q
Give four hypothalmic causes of secondary hypothyroidism?
A
- Congenital
- Infection: encephalitis
- Infiltration: sarcoidosis
- Malignancy: craniopharyngioma
11
Q
What is characterised by: presence of thyroid peroxidase antibodies in blood and T-cell infiltrate and inflammation on microscopy?
A
Autoimmune hypothyroidism aka Hashimoto’s thyroiditis
12
Q
What intolerance do hypothyroidism patients have?
A
Cold intolerance
13
Q
What type of fluid retention do hypothyroidism people get?
A
Pitting oedema
14
Q
Give a cutaneous association wit hhypothyroidism?
A
Vitiligo
15
Q
Name four cardiac symptoms of hypothyroidism?
A
- Reduced heart rate
- Cardiac dilatation
- Pericardial effusion
- Worsening of heart failure
16
Q
Name one metabolic sign of hypothyroidism?
A
Hyperlipidaemia
Decreased appetite
Weight gain
17
Q
Name three GI signs of hypothyroidism?
A
- Constipation
- Megacolon
- Ascites
18
Q
Give three respiratory signs of hypothyroidism?
A
- Deep hoarse voice
- Macroglossia
- Obstructive sleep apnoea
19
Q
What are these symptoms seen in: decreased intellectual and motor activities, dpression and psychosis, muscle stiffness, peripheral neuropathy and prolongation of tendon jerks?
A
Hypothyroidism
20
Q
What condition of the wrist is seen in hypothyroidism?
A
Carpal tunnel syndrome
21
Q
Give three gynaecology issues with hypothyroidism?
A
- Menorrhagia
- Later oligo-or amenorrhoea
- Hyperprolactinaemia - increase TRH causes, increase prolactin secretion
22
Q
What is macrocytosis typical in and what should be ruled out?
A
Hypothyroidism and rule out a concurrent vitamin B12 deficiency
23
Q
In hypothyroidism - is LDL cholesterol and CK increased or decreased?
A
Increased
24
Q
What condition has 70-80% anti-TPO antibody, 30-50% anti-thyroglobulin antibody and 70-100% TSH receptor antibody?
A
Graves disease
25
What thyroid condition has 95% anti-TPO antibody, 60% anti-thyroglobulin antibody and 10-20% TSH receptor antibody?
Autoimmune hypothyroidism
26
What should be given to younger patients with hypothyroidism?
Thyroxine 50-100 ug daily
27
What should be given to elderly patients with IHD and hypothyroidism?
Thyroxine at 25-50ug daily, adjusted every 4 weeks to response
28
What should be checked in hypothyroidism patients adter 2 months of any dose change?
TSH
29
When might thyroxine (T4) doses by increased in a patient?
By 25-50% in pregnancy - increased TBG
30
What is the difference between primary and secondary hypothyroidism?
1. TSH reflects tissue thyroid hormone actions in primary and it is not a useful in secondary as it will remain low if T4 therapy is commenced.
2. TSH is an index of therapeutic success and potential toxicity in primary and T4 is used to monitor treatment in secondary.
31
What affects elderly women with long standing but frequently unrecognized or untreated hypothyroidism
Myxoedema coma
32
In relation to hypothyroidism - what does ECG: bradycardia, low voltage complexes, varying degrees of heart block, Twave inversion and prolongation of QT interval suggest?
Myxoedema coma
33
Name two cardiac symptoms and two sympathetic symptoms of hyperthyroidism?
1, Palpitations/AF
2. Cardiac failure
3. Tremor
4. Sweating
34
Give three vision symptoms of hyperthyroidism?
1. Lid retraction
2. Double vision
3. Eyes that bulge out or protrude in patients with Graves
35
What happens to menstrual cycle in hyperthyroidism?
1. Lighter bleeding and less frequent periods
36
Name an autoimmune cause of Hyperthyroidism?
Graves disease
37
Name two nodular thyroid causes of hyperthyroidism?
1. Multinodular goitre
| 2. Toxic nodule
38
Name two thyroiditis (inflammation) causes of hyperthyroidism?
Subacute and post-partum
39
Name two medications and one supplement which cause hyperthyroidism (iodine causes)?
Amiodarone, thyroxine and kelp
40
What antibody is positive in Graves?
TRAbs - TSH receptor antibody
41
What test other than TSH and antibody positive is used for Graves?
1. Smooth symmetrical goitre - scintigraphy - high uptake/ultrasound
42
What is Graves natural progression?
At 18 months 50% will have burnt out and 50% will relapse
43
What do lid retraction, lid lag, chemosis, proptosis, visual loss and diplopia signs of?
Graves
44
What cause of hyperthyroidism are older patients more likely to get
Nodular thyroid disease
45
Name two tests other than TSH that are used for Nodular thyroid disease?
1. Antibody negative TRAbs
| 2. Assymetrical goitre
46
How is a thyroid storm treatd?
1. Lugols iodine
2. Glucocorticoids
3. PTU
4. B-blockers
5. fluids and monitoring
47
Name two medications used to treat hyperthyroidsim?
1. Carbimazole
| 2. Propylthiouracil (preferred in pregnancy)
48
What is there a risk of with medication for hyperthyroidism?
Agranullocytosis
49
What can be used to treat symptoms in hyperthyroidism?
Beta-blockers
50
What type of thyroiditis is viral triggered and may be associated with throat/fever/other viral symptoms?
De Quervains
51
What tests are there for De Quervains/ sub-acute thyroiditis?
1. T4- high in early stage, low in late
2. TSH - low in early stage, high in late
3. Scintigraphy Scan - low uptake
52
What areas does amiodarone induced thyrotoxicosi occur more frequently in?
Low iodine intake
53
What areas does amiodarone induced hypothyroidism occur more frequenly in?
High iodine intake
54
What embryological thyroid abnormalities result from failure of descent? excessive descent? thyroglossal duct cyst?
Linguial thyroid
Retrosternal location in mediastinum
thyroglossal duct cyst
55
What is the thyroid composed of?
Follicles
56
What are each follcie surrounded by in the thyroid?
Flat to cuboidal follicular epithelial cells
57
What is in the centre of each follicle?
Thyroglobulin
58
What cells present in the thyroid are large with a clear cytoplasm, secrete calcitonion and reult in lower serum Ca levels?
Parafollicular C cells
59
What do polymorphisms in CTLA-4 nad PTPN-22 cause?
Autoimmune thyroditis
60
What are the triad of features in graves disease?
1. Hyperthyroidism with diffuse enlargement of the thyroid
2. Eye changes
3. Pretibial myxoedema
61
What two anti-thyroid antibodies are found in hashimotos thyroiditis#?
1. Anti-thyroglobulin
| 2. Anti-peroxidase
62
In Hashimotos thyroiditis = what cells may mediate destruction of thyroid epithelium?
CD8+
63
What do orphan ani nuclei make the diagnosis of?
Papillary carcinoma
64
What does a medullary carcinoma come from?
C cell hyperplasia
65
What is parathyroid composed of?
Chief cells - secrete PTH, act on Ca homeostasis
66
What is the parathyroid supported by?
Oxyphil cells - slightly larger cells with acidophilic cytoplasm
67
What does chronic hypocalcaemia cause?
Compensatory over activity of parathhyroid glands
68
What type of hperparathyroidism is associated with hypercalcaemia?
Tertiary
69
What do bone disease, nephrolithiasis (stones), constipation, depression and weakn ess and fatigue suggeest?
Hyperparathyroidism
70
What might suggest hypoparathyroidism on ECG?
Prolonged QT interval
71
What are the three key events in ovarian cycle?
1. Follicular growth
2. Ovulation
3. Luteal function
72
What hormone is produced when follicle is present in pregnancy?
Oestradiol
73
What hormone is produced when follicle is implanted in pregnancy?
HCG - pregnancy test
74
What hormone is released when corpus luteum is left in pregnancy?
Progesterone
75
What hormone is released when placenta is in place during pregnancy?
Human Placental Lactogen
76
What hormone does pituitary release in pregnancy?
Prolactin
77
What two hormines increase insulin resistance in the mother?
1. Progesterones
| 2. Human Placenta Lactogen
78
When does gestational diabetes usually come?
In last third of pregnancy
79
When does foetal organogensis start?
At 5 weeks
80
Name three complications of gestational diabetes?
1. Macrosomia
2. Polyhydramnios
3. Intrauterine death
81
Name three complications of type I and II diabetes in pregnancy?
1. Congenital malformation
2. Prematurity
3. Intra-uterine growth retardation
82
What does foetal hyperinsulinemia lead to?
Macrosomia
83
What two drugs should be avoided in type I and Ii diabetic prenancy management>
1. Statins
| 2. ACE inhibitors
84
Name a drug used to treat MODY?
Glibenclamide
85
What should be done 6 weeks post natal in gestational diabetic patients?
Glucose tolerance testing
86
If you get gestational diabetes what are the chances of becoming type II diabetic after 10-15 years?
50%
87
Name a good drug to control blood pressure in gestational diabetes?
Methyldopa
88
What causes anovulatory cycles?
Hypo/hyperthyroidism
89
What can HCG lower and increase in pregnancy?
Low TSH and increase fT4
90
What does a high HCG in pregnancy cause?
Morning sickness and extreme vomiting
91
Does the thyroid get bigger in pregnancy?
Yed
92
In a hypothyroidism pregnant patient - what levels should TSH be aimed for in first trimestter and second/third?
First -
93
What do TSH and HCG do to thyroxine?
Increase it
94
What condition in pregnancy causes infertility, spontaneous miscarriage, stillbirth, thyroid criss in labour and transietn neonatal thyrotoxicosis?
Hyperthyroidism
95
If using drugs to treat hyperthyroidism in pregnancy - what two should be used and when?
Propylthiouracil in first rimester
| Carbimazole in second and third
96
Give some complications of carnbimazole?
1. Scalp abnormalities
| 2. Choanal anf oesophageal atresia
97
Give two complications of propylthiouracil?
1.rISK OF LIVER TOXICITY
98
What is caused when TRAb antibodies cross the placenta?
Neonatal transient hyperthyroidism
99
Name two hormones released from hypothalamus and stored in posterior pituitary?
1. vASOPRESSIN
| 2. Oxytocin
100
What does CRH cause release of in the pituitary?
ACTH
101
What does TRH cause release of in the pituitary?
TSH
102
What does GnRH cause release of in pituitary?
LH/FSH
103
What does GHRH cause release of in the pituitary?
GH
104
What does DA cause release of in pituirtary?
PRL
105
What hormones pair with LH/FSH in the peripheral?
Testosterone or estradiol
106
What hormone pairs with GH in peripheral?
IGF-1
107
Name a dynamic pituitary test?
Insulin Stress Test
108
In a water deprivation test if ur/serum osmol ration is >2 what does it mean?
Normal
109
What dynamic pituitary function test would you do (stimulation_ of IHD patients?
Prolonged glucagon test
110
What is the cause of compression on optic chiasm, compression on cranil nerves, hypoadrenalism, hypothyroidism, hypogonadism, DI and GH deficiency?
Non functioning pituitary adenoma
111
What does dopamine inhibit?
PROLACTIN
112
Name a dopamine antagonist which raises prolactin?
Metoclopramide
113
Do antidepressants raise prolactin?
YES
114
Name three pathological causes of raised prolactin?
1. Hypothyroidism
2. Stalk lesions
3. Prolactinoma
115
Do females or males present first with prolactinoma?
Females first
116
What does galactorrhoea, menstrual irregularity, ammenorrhoea and infertility suggest?
Prolactinoma
117
What drugs are used to treat prolactinoma?
Dopamine agonists- bromocriptine, quinagolide and cabergoline
118
Name two local pituitary effects acromegaly patients get?
Visual fields and hypopituitarism
119
What are two tests for acromegaly?
IGF-1 and GTT
120
What are cabergoline, octreotide and pegvisomant used to treat?
Acromegaly
121
What drugs used in acromegaly reduce GH in mosy patients?
Somatostatin analogues
122
Name a few side effects of somatostatin analogues?
1. Local stinging
2. Flatulemce, diarrhoea, abdo pain
3. Gastritis
4. Gallstones
123
Name a GH antagonist used in acromegaly?
Pegvisomant - last line as so expensive
