20 - Thyroid Disease Flashcards
What is a goitre and what can it be caused by?
- Iodine deficiency
- Selenium deficiency
- Tumours
- Thyroid disease
What is Hashimoto’s diesease and how is it treated?
- Antibody blocks TSH receptor on follicle cells preventing them responding to TSH
- Treated with oral thyroxine and dose is adjusted based on patients signs, symptoms and levels of TSH
What are some causes of Hypothyroidism and what are the general symptoms?
- Weight gain
- Tiredness and lethargy
- Weakness, muscle cramps and cerebellar ataxia
- Dry flaky skin
- Deep husky voice
- Cold intolerance
What are some signs of cretinism?
What is myxedma?
- Severe hypothyroidism in adults
Symptoms:
- Thick puffy skin
- Muscle weakness
- Slow speech
- Mental deterioration
- Intolerance to cold
What are some causes and symptoms of hyperthyroidism?
- Heat intolerance, increased oxygen consumption and increased BMR
- Weight loss
- Physical and mental hyperactivity
- Tachycardia
- Intestinal hyper-mobility
- Skeletal and cardiac myopathy so tired, weak and breathless
- Osteoporosis due to increased bone turnover
What is Grave’s disease?
- TSI antibodies prodcued that stimulate TSH receptors on follicle cells
How can you treat Grave’s disease?
- Carbimazole (or propylthiouracil) : inhibits thyroid peroxidase so iodination and coupling of tyrosine residues on thyroglobulin doesn’t work
- Beta blockers for symptom control
- Surgery for cosmetics
- Radioactive iodine (not in pregnancy)
What examination can you use to look at the thyroid function?
More colour there is the more active it is so in hypothyroidism will be very faint
C
What are some causes of hyperprolactinaemia apart from pituitary adenoma?
What drug is used to treat hyperprolactinaemia?
What is an issue that can be encountered when measuring prolactin levels in the blood with a macroprolactinoma?
How can you distinguish between hyperthyroidism and anxiety?
Hands are warm and moist in hyperthyroidism but in anxiety they are cold
What are some tests you could do to rule out a pituitary adenoma over hyperthyroidism?
- Neck exam
- Hand tremors
- Visual field test
A patient has the following symptoms, what differential diagnoses should you be thinking about?
- Chronic fatigue
- Hypothyroidism
- Anaemia
- Depression
How do you treat hypothyroidism and what are the dangers of treatment?
- Daily levothyroxine
- Can cause hyperthyroidism and cardiac effects if not poorly controlled
Why might this patient be struggling to concieve?
Prolactin negatively feedsback on GnRH so FSH and LH not released so cannot ovulate
What are some physical examinations of the thyroid gland that you can carry out?
What are some of the symptoms and signs of hypothyroidism?
What are some signs and symptoms of hyperthyroidism?
What are some red flag symptoms of thyroid cancer?
A 44 year old female patient is shown to have normal free plasma T3 and T4 but undetectable TSH. Which condition best describes this scenario
Subclinical hyperthyroidism is characterized by a low or undetectable concentration of serum TSH with free triiodothyronine and free thyroxine levels within laboratory reference ranges
What effect can amiodarone have on the thyroid?
The antiarrhythmic drug amiodarone is structurally similar to thyroxine and so can disrupt thyroid function (both hypo- and hperthyroid effects have been reported with this drug
