Manz Endocrine > Thyroid Disorders > Flashcards

Thyroid Disorders Flashcards

(41 cards)

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1
Q

`How does hypothyroidism present?

A
  • Weight Gain
  • Cold intolerance
  • Brittle nails, thin/dry skin & hair
  • Hyporeflexia, slow speech
  • Lethargy & low mood
  • Constipation
  • Bradycardia
  • Heavy periods

Severe cases can cause puffy face, large tongue, hoarseness and coma

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2
Q

How does hyperthyroidism present?

A
  • Weight loss
  • Heat intolerance
  • Muscle weakness
  • Hyperreflexia
  • Frequent bowel movements
  • Palpitations
  • Light periods
  • Sweaty palms
  • Thyroid eye symptoms (bulging)
  • Anxiety/irritibility
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3
Q

How does gender affect thyroid disease?

A

Both hyper and hypothyroidism are much more common in women

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4
Q

What are the types of Hypothyroidism?

A

Primary
Subclinical
Secondary

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5
Q

What causes congenital Hypothyroidism?

A
  • developmental problems e.g. agenesis

- Dyshormogenensis (autosomal recessive condition preventing TH production)

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6
Q

What causes acquired Primary Hypothyroidism?

A
  • Autoimmune (hashimoto’s) thyroiditis
  • Iatrogenic
  • Chronic Iodine Deficiency
  • Post-subacute thyroiditis
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7
Q

What can cause secondary or tertiary hypothyroidism?

A
  • Pituitary tumours
  • Craniopharyngioma
  • Pituitary surgery/radiotherapy
  • Sheehan’s Syndrome
  • Isolated TRH deficiency
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8
Q

What is Sheehan’s Syndrome?

A

Post-partum ischaemic necrosis of the pituitary due to blood loss/hypovolaemic shock of childbirth

Its a potential cause of secondary hypothyroidism

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9
Q

List some iatrogenic causes of primary hypothyroidism?

A

Post op
Radioactive Iodine or Anti-Thyroids
Amiodarone (Sub-acute thyroiditis)
RT for H/N cancer

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10
Q

What tests would you run for suspected hypothyroidism?

A
  • TFTs i.e. TSH & fT4
  • Anti-Thyroid Peroxidase Antibodies (Hashimotos)
  • FBC
  • Lipids
  • Serum Na+
  • Muscle enzymes, ALT & CK
  • Prolactin
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11
Q

Explain why youd do each test for hypothyroidism?

A 
FBC - Raised MCV (RBC size)
Lipids - Hypercholesterolaemia
Na+ - Hyponatremia due to excess ADH from hypothyroidism
Muscle enzymes, ALT  & CK are all raised
Prolactin - Hyperprolactinaemia
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12
Q

How will TFT’s Appear for each class of Hypothyridism?

A

Primary - Low fT4 but high TSH
Secondary - Low fT4 & low or normal TSH
Subclinical - Normal fT4 & High TSH

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13
Q

What do we use to manage hypothyroidism?

A

Levothyroxine (T4) tablets

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14
Q

Explain the dosing of Levothyroxine?

A

Start at 50mcg/day
Titrate up to 100mcg/day after 2 weeks
Keep increasing until their TSH (primary disease) or fT4 (Secondary Disease) is normal.

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15
Q

What special cases affect how you use Levothyroxine?

A
  • IHD needs to be started lower and titrated slowly as it can trigger Angina
  • Pregnant women need more T4
  • Myxedema Coma needs IV T3
  • Post-partum Thyroiditis needs to have the meds removed for 6 weeks and TFTs measured to see when it abates
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16
Q

Should we treat subclinical hypothyroidism?

A

Only if:

  • TSH >10
  • > 5 + Antibodies
  • TSH elevated + symptoms (temporary trial therapy for symptom improvement)
  • Pregnant or planning pregnancy
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17
Q

What are the risks of levothyroxine?

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A
  • Thyrotoxicosis
  • AF
  • Osteopenia
18
Q

How does Goitre occur in hypothyroidism?

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A

No fT4
No -ve feedback
Excess TSH
Hyperstimulation -> Hyperplasia of Thyroid gland

19
Q

What are the causes for Primary hyperthyroidism?

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A

Graves Disease - 70%
Toxic Multinodular Goitre - 20% (Plummers Disease)
Thyroid Adenoma
Subacute Thyroiditis
Solitary Toxic Thyroid Nodule (benign adenoma)

20
Q

What is Grave’s Disease?

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A

Autoimmune condition in which TSH receptor antibodies continuously stimulate the thyroid causing PRimary hyperthyroidism

21
Q

What is Toxic Multinodular goitre?

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A

Multinodular Goitre producing excess thyroid hormones

22
Q

Whats the main cause of secondary hyperthyroidism?

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A

Pituitary Adenoma producing TSH

23
Q

What is Thyrotoxicosis without hyperthyroidism?

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A

Where you get excess thyroid hormone without hyperthyroidism.

Due to exogenous thyroxine or destructive thyroiditis causing stores of thyroid hormones to be released

24
Q

What causes destructive thyroiditis?

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A

Post-partum
Amiodarone induced

Most common causes

25
How do you diagnose Hyperthyroidism?
Based on the presentation and TFTs Can do TSH receptor antibody test for Grave's Specifically
26
Describe how hyperthyroidism TFTs appear?
Primary - High fT4 & low TSH Secondary - High fT4 & High TSH Subclinical - Normal fT4 & low TSH
27
How is Hyperthyroidism treated?
1st) Anti-thyroid Drugs (ATDs) 2nd) Radioiodine Resection of thyroid or pituitary adenoma
28
How are anti-thyroid drugs used?
Carbimazole or Propylthiourcil A titration regimen for 12-18 months then move on to radioiodine if uncured
29
How is Radioiodine used?
For hyperthyroidism USed after ATDs fail High dose ablative regimen cures 90% of patients but leaves 70% hypothyroid
30
When would we treat Subclinical hyperthyroidism?
If: - Elderly - Persistant subclinical hyperthyroidism - High cardiac risk patient
31
Risks of Hyperthyroidism treatments?
ATDs can cause a rash and agranulocytosis which is a rare and potentially fatal complication Radioiodine makes ~70% of patients hypothyroid and can cause eye disease
32
How would you investigate a goitre?
- TFTs - Isotope scabn - US - FNA - CXR for retrosternal extension IF you suspect cancer a serum calcitonin to rule out MEdullary Thyroid Cancer
33
What are the main types of thyroid cancer?
Most common: Papillary Follicular Others: Anaplastic Lymphomas Medullary Carcinoma
34
How do Differentiated Thyroid Carcinomas spread?
Papillary carcinomas spread to local lymph nodes Follicular Carcinomas metastasise to lung/blood/bone
35
What is medullary thyroid cancer?
Cancer of C cells in the thyroid gland Produces calcitonin Associated with MEN 2
36
Treatments for Thyroid cancers?
High Dose radioiodine Long-Term levothyroxine to suppress the tumour Lymphoma - External RT/chemo Anaplastic - Can be delayed with external RT Thyroidectomy - Only treatment that works on medullary thyroid cancer
37
When would we stop Levothyroxine for Thyroid cancer?
Withdraw from the thyroxine for 2 weeks as a trial and do a full body radioisotope scan to see if its all gone
38
Features of Thyroid Storm
Acute severe associated with untreated hyperthyroidism: Pyrexia Tachycardia Delerium
39
What is De Queverns Thyroiditis
``` Viral infection - Neck tenderness/pain -Dysphagia -Hyperthyroidism Often self limiting with supportive care ```
40
Presentations of Graves
Exophthalmos Pretibial myxedema Diffuse Goitre
41
Presentation of Toxic Multinodular Goitre
Firm nodules on palpation
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