O GoConqr está de visual novo! Conte para nós o que você achou.

Registre-se grátis

Flashcards

Thyroid

Anna Hogarth Met3B Inglês 50 flashcards

Flashcards do conjunto (50)

  1. 1What are the causes of a diffuse goitre?Physiological
    Grave's disease
    Hashimoto's thyroiditis
    Subacute (De Quervain's) thyroiditis
    Endemic (iodine deficiency)
  2. 2What are the causes of a nodular goitre?Multinodular goitre - often euthyroid, may become hyperthyroid
    Adenoma (solitary thyroid nodule)
    Carcinoma - often euthyroid (solitary thyroid nodule)
    Cyst (often euthyroid, single thyroid nodule)
  3. 3What is the point of isotope scanning in thyroid lesions?Determine the cause of hyperthyroidism and to detect retrosternal goitre, ectopic thyroid tissue and thyroid metastasis.
    If there is a suspicious nodule:
    Hot - mostly not malignant
    Neutral - mostly not malignant
    Cold - 20% are malignant
  4. 4What is the point of USS in thyroid lesions?Distinguishes cystic from solid (potentially malignant) nodules.
  5. 5What is the purpose of fine needle aspirates?Do determine whether there is a thyroid cancer
  6. 6Why is a CXR done when looking at goitres?CXR with thoracic inlet view - tracheal goitres and metastases
  7. 7When can impalpable nodules be observed without intervention if found on USS?1) If less than 1cm and asymptomatic (USS can see nodules of <0.2cm)
    2) There is no past history of thyroid cancer or neck irradiation
    3) No family history of medullary cancer
  8. 8What is the most common form thyroid cancer? Who does it affect? How does it spread? How is it managed?1) Papillary - 60%
    2) Younger patients
    3) Lymph nodes and lung (jugulodigastric node metastasis = aberrant thyroid)
    4) Total thyroidectomy +/- nodule excision +/- radioiodine (131I). Give Levothyroxine to suppress TSH
  9. 9How common is follicular thyroid cancer? Who does it affect? How does it spread? How is it managed?1) 25% of thyroid cancers
    2) Occurs in middle-age
    3) Spreads early via blood to bones and lungs
    4) Total thyroidectomy + T4 suppression + radioiodine ablation
  10. 10How common is medullary thyroid cancer? What causes it? What can be used as a tumour marker? How do they differ from other thyroid tumours? How is it managed?1) 5%
    2) Sporadic (80%) or as part of MEN syndrome
    3) Calcitonin
    4) They do not concentrate iodine
    5) Perform pheochromocytoma screen pre-operatively. Thyroidectomy + node clearance. External beam radiography regional recurrence
  11. 11How common are lymphoma thyroid cancers? Who does it affect? How does it present? How is it managed?1) 5%
    2) Women 3:1
    3) Possibly stridor or dysphagia
    4) Full staging pre-treatment with chemoradiotherapy. Assess histology for MALT origin (better prognosis)
  12. 12How common are anaplastic thyroid cancers? Who does it affect? How is it managed?1) Rare
    2) Elderly patients, women 3:1
    3) Usually has a very poor prognosis, if it is not unresectable, can try excision + radiotherapy
  13. 13When is a partial lobectomy or a lobectomy performed? When is thyroidectomy performed?1) When there are isolated nodules
    2) Cancers, MNG or Grave's
  14. 14What are the indications for surgery?1. Cancer
    2. Pressure symptoms
    3. Relapse of hyperthyroidism after >1 failed drug course
    4. Cosmetic reasons
    5. Symptomatic patients planning pregnancy
    6. Rapid growth
    7. Dominant nodule on scintigraphy
    8. Nodule >3cm
    9. Hypoechogenicity
  15. 15What are the preoperative management steps for thyroid management?1) Render patient euthyroid pre-op (carbimazole, up to 20mg/12h or propylthiouracil 200mg/12h) but stop drugs 10d before surgery as they increase vascularity.
    2) Propranolol (up 80mg/h) to control tachycardia and tremor associated with hyperthyroidism, continue for 5d post op
    3) Check vocal cords with direct laryngoscopy pre- and post-op for risk of recurrent laryngeal injury
    4) Check serum Ca2+ and PTH post-op
  16. 16What are the complications associated with thyroid surgery?1) Recurrent laryngeal injury (hoarse voice)
    2) Thyroid storm (severe hyperthyroidism: high temp; agitation; confusion; coma; tachycardia; AF; D&V; acute abdomen; heart failure; coma)
    3) Hypoparathyroidism
    4) Tracheal obstruction due to haematoma - remove clips etc. immediately
    5) Late complications in hypothyroidism and recurrent hyperparathyroidism
  17. 17What are the symptoms associated with thyrotoxicosis?Diarrhoea
    Weight loss (10% have increase)
    Increased appetite
    Palpitations
    Heat intolerance
    Amenorrhoea/oligomenorrhoea/inferility
    Low libido
    Heat intolerance
    Sweating
    Warm skin
    Tremor
    Rarely: psychosis; chorea; itch; alopecia; utricaria
  18. 18What are the signs associated with thyrotoxicosis?1) Fast (irregular) pulse - AF in ~25%
    2) Hypertension
    3) Warm moist skin
    4) Fine tremor
    5) Lid lag
    6) Lid retraction
    7) Can cause hyperglycaemia
    8) There may be a goitre, nodules or bruit depending on the cause
  19. 19What signs are specifically associated with Grave's?1) Eye disease (exophthalmus, ophthalmoplegia)
    2) Pretibial myxedema (oedematous swelling above the lateral malleoli)
    3) Thyroid acropachy (painful finger and toes swelling with clubbing, periosteal reaction in long bones)
  20. 20What are the causes of thyrotoxicosis?1) Grave's
    2) Toxic multinodular goitre (usually euthyroid; seen in elderly patients and iodine-deficienct areas. Surgery if there are compressive symptoms)
    3) Toxic adenoma (will see hot nodule)
    4) Ectopic thyroid tissue
    5) Exogenous (Iodine excess i.e. due to food contamination or contrast media)
    6) Subacute De Quervain's thyrotoxicosis
    7) Post-partum
    8) Drugs
    9) TB (rare)
  21. 21Which drugs can cause thyrotoxicosis?Lithium - although more commonly causes hypothyroidism
    Amiodarone (iodine-rich drug, structurally like T4). Can cause toxicity which leads to reduce thyroid hormone production and hypothyroidism. Can also cause thyrotoxicosis via a destructive thyroiditis - cell death and release of hormone. Will not show increased radioiodine uptake and can be managed with glucocorticoids.
  22. 22How does Grave's cause thyrotoxicosis? Who gets it? Precipitating factors?Antibodies to the TSH (thyrotropin) receptor on the thyroid stimulate excessive thyroid hormone production (Especially T3) and cause growth of thyroid. Cross reacts with orbital antigens.
    2) 2/3 of cases of hyperthyroidism (0.5% prevalence). Women 9:1
    3) Stress, illness and pregnancy. Associated with other autoimmune conditions.
  23. 23Which auto-antibodies are present in Graves and Hashimotos?Anti-TPO and anti-thyroglobulin are found in both.
    Anti-TSH is Grave's only
  24. 24How does De Quervain's present?Hyperthyroidism and painful goitre - may progress to hypothyroidism. Manage with NSAIDs.
  25. 25How is thyrotoxicosis investigated?1) TSH, T4 and T3 levels
    2) Auto-antbodies
    3) Look for mild normocytic anaemia, mild neutropenia (Grave's), raised ESR, raised Ca2+, raised LFTs
    4) Isotope scan if cause is unclear (nodular disease or subacute thyroiditis)
    5) Test visual fields, acuity and eye movements if ophthalmopathy is present
  26. 26How is thyrotoxicosis managed?1) Drugs
    2) Radioiodine
    3) Thyroidectomy
  27. 27Which drugs are used?1) Beta-blockers to get immediate control of symptoms e.g. propranolol 40mg/6h
    2) Carbimazole - either titrate upwards or give in block regime with levothyroxine simultaneously to prevent iatrogenic hypothyroidism
  28. 28How are drugs used in Grave's?Give the anti-thyroid drugs for 12-18 months and then withdraw. Around 50% will relapse, requiring radio-iodine or surgery
  29. 29What are the side effects of Carbimazole?Agranulocytosis - beware severe sepsis. Warn to stop and get urgent FBC if signs of infection
  30. 30Who is radioiodine CI in? Cautioned in?1) Pregnancy and breastfeeding women
    2) Active hyperthyroidism, can result in a thyroid storm
  31. 31What is the prevalence of hypothyroidism? Who is it most common in?1) 4/1,000/yr
    2) Over the age of 40, women 4:1
  32. 32Symptoms of hypothyroidism?Cold, weight gain, lethargy, lowe mood, constipation, menorrhagia, hoarse voice, poor memory/cognition, dementia, myalgia, cramps, weakness
  33. 33What are the signs of hypothyroidism?B
    1) R -reflexes relax slowly
    2) A - ataxia (cerebellar)
    3) D - dry/thin hair skn
    4) Y - yawning/tired/coma
    5) C - cold hands (+/- low temp)
    6) A - ascites (+/- non-pitting oedema, pleural effusions etc.)
    7) R - round puffy face/double chin/obese
    8) D - defeated demeanour
    9) I - immobile +/- ileus
    10) C - CCF
    Also myopathy, neuropathy and goitre
  34. 34What are the causes of primary autoimmune hypothyroidism? Which is associated with a goitre?1) Primary atrophic hypothyroidism (women 6:1, common). Diffuse lymphocytic infiltration of the thyroid leading to atrophy, hence no goitre
    2) Hashimoto's thyroiditis. Goitre due to lymphocytic infiltration. Most common in women aged between 60-70yrs. May be hypothyroid or euthyroid. Rarely an initial period of hyperthyroid (Hashitoxicosis). Very high autoantibody titres
  35. 35What are the other causes of hypothyroidism?1) Iodine deficiency (greatest cause worldwide)
    2) Post-thyroidectomy or iodine treatment
    3) Drug-induced: antithyroid drugs; amiodarone; lithium; iodine
    4) Subacute thyroiditis - temporary hypothyroidism after hyperthyroid phase
  36. 36What causes secondary hypothyroidism?Insufficient TSH, i.e. hypopituitarism (very rare)
  37. 37What problems occur in pregnancy with hypothyroidism?Eclampsia, anaemia, prematurity, low birth weight, still birth PPH
  38. 38How is hypothyroidism managed in the healthy and young? What levels should TSH be? How long do you have to wait to check TSH levels after adjusting the dose? How often should these patients be reviewed?1) Levothyroxine (0-100 mcg/24h). Review at 12 weeks. Adjust 6 weekly by clinical state.
    2) Keep TSH above 0.5mu/L
    3) Thyroxine has a 7 day half life, so wait 4 weeks before checking TSH
  39. 39How is hypothyroidism managed in the elderly or those with IHD?Start with 25mcg/24h; increase dose by 25mcg/24h according to TSH at 6 weeks. Use caution as levothyroxine can precipitate angina or MI
  40. 40What is a myoexedema coma?Hypothyroid state before death - often over 65, hyporeflexia, hypothermia, hypoglycaemia, bradycardia, seizures.
    Precipitants: infection, MI, stroke or trauma
  41. 41What does the following indicate: High TSH, Low T4?Hypothyroidism
  42. 42What does the following indicate: High TSH, normal T4?Subclinical or treated hypothyroidism
  43. 43What does the following indicate: High TSH, high T4?TSH secreting tumour or thyroid hormone resistance
  44. 44What does the following indicate: High TSH, High T4, Low T3?Slow conversion of T4 to T3 due to deiodinase deficiency or euthyroid hyperthyroxinaemia. Or thyroid hormone antibody artefact
  45. 45What does the following indicate: Low TSH, High T4 or High T3?Hyperthyroidism
  46. 46What does the following indicate: Low TSH, normal T4 and T3?Subclinical hyperthyroidism
  47. 47What does the following indicate: Low TSH, low T4Central hypothyroidism (hypothalamic or pituitary disorder)
  48. 48What does the following indicate: Low TSH, low T4 and T3?Sick euthyroidism (in very unwell patients, thyroid tests are deranged)
    Pituitary disease
  49. 49Normal TSH, abnormal T4Consider changes in thyroid-binding globulin, assay interference, amiodarone, or pituitary TSH tumour
  50. 50What causes thyroglobulin hormone to increase? Decrease?1) Pregnancy and oestrogen therapy
    2) Nephrotic syndrome and malnutrition (protein loss); drugs (androgens, corticosteroids and phenytoin); chronic liver disease and acromegaly.

Informações

Descrição
Met3B (Endocrinology) FlashCards sobre Thyroid, criado por Anna Hogarth em 07-03-2020.
Criado por
Anna Hogarth
Visualizações
0
Avaliação

Mais sobre Thyroid Gland and Thyroid Disorders

Fale Conosco

Sobre o que é sua mensagem?

O que você acha do novo visual?

Você gostou?