MEH > 13 Thyroid Disorders > Flashcards

13 Thyroid Disorders Flashcards

(49 cards)

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1
Q

What is primary hypothyroidism?
thyroid function test results

A

Low levels of blood T4 due to a problem of thyroid gland itself (often autoimmune)

T3/T4 low
TSH high

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2
Q

What is secondary hypothyroidism?
thyroid function test results

A

Low levels of T4 due to TSH deficiency (pituitary disease)
.
low T4
non elevated TSH

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3
Q

What is subclinical hypothyroidism?
thyroid function test results

A

Normal fT4 with elevated TSH

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4
Q

Treatment of subclinical hypothyroidism

A

Treatment is not always needed if asymptomatic
if TSH >10miU/L then thyroxine should be prescribed
or TSH 5-10miU/L in women planning pregnancy

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5
Q

Causes of primary hypothyroidism

A
  • autoimmunity e.g. hashimoto’s disease - most common
  • iodine deficiency
  • post surgery or radiation
  • medication e.g. amiodarone, lithium
  • dyshormonogensis - hereditary defects in thyroid hormone synthesis
  • pregnancy
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6
Q

Causes of secondary hypothyroidism

A

TSH deficiency due to hypothalamic-pituitary disease

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7
Q

Symptoms of hypothyroidism

A

lethargy
Weight gain/change in appearance
Puffy eyes (myxoedema)
Cold intolerance
Dry hair/skin
Joint/muscle ache
Constipation

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8
Q

Signs of hypothyroidism

A
  • Bradycardia
  • Slow-relaxing reflexes
  • Peaches and cream-smooth pale skin, pink cheeks
  • loss of eyebrows
  • Pre-orbital oedema
  • Carpal tunnel syndrome
  • cold hands
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9
Q

What does the sign of peaches and cream mean?

A

Smooth pale skin with pink cheeks

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10
Q

Investigations of hypothryoidism

A
  • TFTs
  • autoantibodies test (thyroid peroxide in Hasimoto’s disease)
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11
Q

Treatment of hypothyroidism

A

Thyroxine replacement therapy T4 for life
Caution needed in elderly and heart disease (lower dose needed)

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12
Q

Aims of treatment of hypothyroidism
what do the TSH levels indicate?

A

Resolution of symptoms
Normalisation of blood tests after 6-8 weeks
High TSH indicates under-replacement
Low TSH indicates over-replacement

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13
Q

What is primary hyperthyroidism/thyrotoxicosis?
thyroid function test results

A

High levels of thyroid hormones due to an overactive thyroid gland

T3/T4 high
TSH low

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14
Q

Causes of hyperthyroidism

A
  • Graves’ disease - most common
  • thyroiditis
  • excessive T4/3 therapy
  • drugs e.g. amiodarone
  • thyroid carcinoma
  • post-partum thyroiditis
  • toxic multinodular goitre
  • ectopic thyroid tissue
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15
Q

Symptoms of hyperthyroidism

A
  • weight loss with increased appetite
  • irritability
  • restlessness/insomnia
  • heat intolerance
  • sweating
  • muscle ache
  • palpitations
  • diarrhoea
  • reduced fertility
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16
Q

Signs of hyperthyroidism

A
  • resting tremor
  • hyperkinesis - state of excessive restlessness
  • resting tachycardia (sinus or atrial fibrillation)
  • warm peripheries
  • hypertension
  • proximal myopathy- symmetrical weakness of limbs
  • lid lag - upper eyelid is higher than normal when looking down
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17
Q

Proximal myopathy meaning

A

Symmetrical weakness in limbs

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18
Q

Lid lag meaning
What is it due to?

A

Upper eyelid is higher than normal when looking down
Increased sympathetic tone in upper eyelid

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19
Q

What is Graves’ disease?

A
  • Autoimmune condition
  • Immune system mistakenly attacks thyroid which cause it to be overactive > hyperthyroidism
  • caused by production of thyroid stimulating immunoglobulin
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20
Q

Clinical signs specific to Graves’ disease

Study These Flashcards
A
  • thyroid eye disease - exophthalmos
  • skin changes > pre tibia myxoedema
  • thyroid acropathy (similar to clubbing)
21
Q

What is nodular thyroid disease?

Study These Flashcards
A

Solid or fluid filled lumps within thyroid

22
Q

Investigations of hyperthyroidism

Study These Flashcards
A
  • TFTs
  • autoimmune antibodies - TSH receptor stimulating antibodies (TSHrAb) for Graves’
  • thyroid USS
  • nuclear imaging - thyroid scintigraphy (to determine cause)
23
Q

What is the imaging process to look at the thyroid gland?

Study These Flashcards
A

Thyroid scintigraphy
Using technetium-99m isotope

24
Q

What is seen on thyroid scintigraphy in the following conditions?
- Graves’ disease
- nodular disease
- thyroiditis
- thyroid cancer

Study These Flashcards
A
  • Graves’ disease: uniform increased uptake
  • nodular disease: increased uptake in autonomonous nodules
  • thyroiditis: absent uptake
  • thyroid cancer: cold/absent area
25
Treatment of hyperthyroidism
- Medication - **thionamides**: *carbimazole* + *propylthiouracil* - B blockers to control symptoms until thyroid function returns to normal *e.g. propranolol* - thyroidectomy - single dose of I131 radioactive iodine
26
What are the medications used to treat hyperthyroidism?
**thionamides** *Carbimazole Propylthiouracil*
27
How do thionamides work? How long does it take? What can be given in the meantime?
- reduces T3/T4 synthesis by preventing thyroid peroxidase from coupling + iodinating tyrosines - 4-6 weeks - B blockers to control symptoms *e..g propranolol*
28
Side effects of thionamides What should patients be warned of?
- rash - bone marrow suppression . - if they get an unexplained fever or sore throat, an urgent FBC is needed to exclude pancytopaenia
29
What must patients be advised to do after being administered radioactive iodine + why?
avoid children + pregnant women for a few week after treatnet a small amount of radiation is emitted post treatment
30
Complications of thyroid surgery
- bleeding - haematoma causing airway obstruction - infection - damage to recurrent laryngeal nerve - damage to parathyroid gland > temporary or permanent hypocalcaemia
31
What is thyroid crisis/storm?
Large amount of thyroxine released in short amount of time Rare complication of hyperthyroidism Medical emergency - life threatening
32
Symptoms of thyroid crisis/storm
Hyperpyrexia >41.5°C Tachycardia Cardiac failure Liver dysfunction
33
What can happen in pregnancy with hyperthyroidism?
In Graves’ disease antibodies can cross placenta Baby can be born with hyperthyroidism
34
What is goitre?
Enlargement of thyroid gland
35
Types of goitre
- **Diffuse goitre**- simple goitre, autoimmune thyroid disease, thyroiditis - **Nodular goitre**- multinodular goitre, solitary nodule RED FLAH SYMPTOM - **Fibrotic goitre**- Riedel’s thyroiditis RARE - **Iodine deficiency**- common worldwide, rare in UK
36
Red flag symptoms of thyroid cancer
Very young or old Rapid enlargement of lump in neck Hoarse voice + dysphagia -swallowing issues Family history Hard irregular thyroid mass Fixed to surrounding structures Cervical lymph nodes
37
Where does a thyroglossal cyst present?
Exact midline Moves up when you stick tongue out
38
Investigation of suspected thyroid cancer
Thyroid ultra-sound Fine needle aspiration CT scan thorax and mediastinum - space within chest
39
What does hypothyroidism cause in infants + adults?
Infants - **cretinism** Adults - **myxoedema**
40
what is severe hypothyroidism in infants + how does it present?
**Cretinism** - dwarfed stature - mental deficiency - poor bone development - slow pulse - muscle weakness
41
What does TRH stand for?
Thryoptropin-releasing hormone
42
Thyroid function test in hashimoto’s disease
Low T3+4 High TSH
43
Thyroid function test in grave’s disease
- increased T3+4 - low TSH
44
What does a high T3/T4 with non suppressed TSH suggest?
TSHoma thyroid hormone resistance assay interference
45
What antibodies are related to thyroid disorders?
- **anti-TPO** - Grave's disease+ Hashimoto's thyroiditis - **anti-thyroglobulin** - Grave's disease, Hashimoto's thyroiditis + thyroid cancer - **TSH receptor antibodies** - Grave's disease
46
TFTs in secondary hypothyroidism
Low T4 Low TSH
47
What is subacute thyroiditis (De Quervain’s thyroiditis)?
Thyrotoxicosis + tender goitre Occurs after viral infection + presents with hyperthyroidism > hypothyroidism over a week weeks-months
48
Management of subacute thyroiditis
Self limiting Aspirin or other NSAIDs for pain - steroids if severe
49
Management of thyroid storm
Hydrocortisone 100mg IV bolus every 6 hours
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