clinical thyroid disease Flashcards
hypothyroidism clinical features
weight gain lethargy feel cold constipation heavy period dry skin/hair bradycardia slow reflexes goitre severe: puffy face, large tongue, hoarseness, coma
hyperthyroidism clinical features
weight loss anxiety/irritable heat intolerance palpitations bowel frequency light periods sweaty palms palpitations hyperreflexia/tremors goitre
hormone levels: 1ry hypothyroidism
raised TSH
Low T4 and T3
hormone levels: compensated hypothyroidism
raised TSH
normal T4 and T3
hormone levels: 2ry hypothyroidism
low TSH
low T4 and T3
causes of 1ry hypothyroidism: congenital
developmental - maldevelopment
dyshormogenesis - trapping/organification
acquired causes of 1ry hypothyroidism
autoimmune: Hashimoto’s
iatrogenic: post-op
chronic iodine deficiency
post-subacute thyroditis
causes of 2ry/3ry hypothyroidism
pituitary/hypothalamic damage
- pituitary tumour
- craniopharyngioma
- post pituitary surgery or radiotherapy
investigating hypothyroidism
TSH/T4
autoantibodies: thyroid peroxidase antibodies
treatment of hypothyroidism
levothyroxine
initial dose 1.6mcg/kg then titrate in 25mcg steps according to TFT
subclinical hypothyroidism
repeat tests after 2-3 months with TPO antibodies
consider treatment =TSH>10
TSH>5 with symptoms - trial therapy 6mo and continue if symptomatic imprivement
hypothyroidism and pregnancy
inc levothyroxine requirements during pregnancy
optimise preconceptually
goitre causes - physiological
puberty
pregnancy
goitre causes - autoimmune
grave’s
hashimoto’s
goitre causes - thyroiditis
acute
chronic fibrotic
goitre types
multinodular diffuse - colloid, simple cysts tumours (adenoma, carcinoma, lymphoma) sarcoidosis tuberculosis
solitary thyroid nodule investigations
thyroid function test
USS (benign vs malignant)
FNA
thyroid cancer - papillary
most common
multi-focal, local spread to lymph nodes
good prognosis
thyroid cancer - follicular
usually single lesion
metastases to lung/bone
good prognosis if resectable
thyroid cancer management
near total thyroidectomy
high dose ablative ratioiodoinde
when is thyroid Ca prognosis poorer
age <16 >45 tumour size spread outside thyroid capsule metastases TNM stage
causes of primary hyperthyroidism
grave’s
toxic mulitnodular goitre
toxic adenoma
causes of 2ry hyperthyroidism
pituitary adenoma secreting TSH
Grave’s disease
autoimmune driven condition
thyroid peroxidase antibodies
TSH receptor antibodies
Grave’s disease diagosis
hyperthyrpidism
TSH receptor antibodies
multinodular goitre
most common cause of thyrotoxicosis in elderly
characteristic goitre and absence Grave’s
subacute thyroiditis
viral trigger
painfull goitre +/- fever, myalgia
ESR raised
may require short term steroids and NSAIDs
antithyroid drugs
carbimazole
titration regime
radioiodine
treat with ATD
usually give high/ablative dose
subclinical hyperthyroidism
TSH suppressed
normal TH
