Disorders of the Thyroid and Adrenal Glands Flashcards
A 32-year old woman presented to her GP with progressive tiredness over the last year since the birth of her daughter. She had gained about 6 kg (about 1 stone) in weight over the previous six months and had no energy to do anything. On direct questioning, she admitted to being constipated, and intolerant of the cold. She noted that her periods were much heavier.
On examination she was pale. Body Mass Index (BMI) was 29kg/m2. Her pulse was 54 beats per minute, and her blood pressure 110/75 mm Hg.
Can you think of some possible diagnoses? Explain your thoughts for each of these.
Primary hyperthyroidism as intolerant to cold and bradycardia and weight gain and slower bowel (constipation) and basal metabolic rate slows down
Possibly depression
Addison’s disease? Cannot make cortisol aka tired ] low blood pressure, but no constipation and no intolerance to cold and usually it’s lose weight (acth controls cortisol production, melanin which will make you more tanned)
Primary hyperthyroidism and iron deficiency anaemia and menorrhagia
A 32-year old woman presented to her GP with progressive tiredness over the last year since the birth of her daughter. She had gained about 6 kg (about 1 stone) in weight over the previous six months and had no energy to do anything. On direct questioning, she admitted to being constipated, and intolerant of the cold. She noted that her periods were much heavier.
On examination she was pale. Body Mass Index (BMI) was 29kg/m2. Her pulse was 54 beats per minute, and her blood pressure 110/75 mm Hg.
What blood tests would help you work out what the correct diagnosis is? Explain your thoughts.
thyroxine, TSH, blood film, (there would be high TSH and low thyroxine, T3/T4), cortisol, acth
- morning is the best time to measure cortisol
- full blood count, haemoglobin
- usually GPs only do TSH, good screening test
- then you would go fro T4
Looking at the blood test results, what is the diagnosis?
primary hyperthyroidism, high TSH and low T4
What treatment is needed for primary hyperthyroidism?
levothyroxine (synthetic version of T4)
