Effects of Hypo- and Hyperthyroidism Flashcards
What are the symptoms of hyperthyroidism?
•Thyroid hormone sets the basic metabolic rate - so everything speeds up when thyroid is overactive
Nervousness, fine tremor
- Heat intolerance, sweating, warm skin
- Weight loss, hyperphagia, diarrhoea
- Palpitations, SOB
- Fatigue, muscle weakness- proximal myopathy
- Menstrual disturbance- irregularity mainly -
Wath are the signs of hyperthyroidism?
- Tachycardia, arrhythmia
- Systolic hypertension
- Warm skin
- Stare and eyelid retraction
- Tremor
- Hyperreflexia
- Proximal muscle weakness
What would the thyroid function tests look like for a hyperactive thyroid?
high TT4/TT3
High FT4 and FT3
loooow TSH
What are the causes of hyperthyroidism?
Graves’ Disease
•Autoimmune: Anti TSH receptor antibodies- antibodies stimulate the gland
Signs:
signs of overactive thyroid in addition to…
- Diffuse goitre
- Exophthalmos- the autoantibodies attack fat in back of eye-
- Lid retraction - you see the whites of the eyes both above and below
•Pretibial myxoedema
Toxic Multinodular Goitre, Toxic Adenoma
- Monoclonal tumours that produce T4/T3 independent of TSH control
- common in Elderly patients
- Nodular goitre
- these patients would have a discrete nodular goitre -
Thyroiditis
- Damage to gland: release of pre-formed hormone into circulation
- Viral, trauma, pregnancy, amiodarone
- Tender gland, absence of goitre, raised ESR\
•TSH secreting tumour (secondary hyperthyroidism)
•Factitious- overdose on hyperthyroid medications
•Ectopic thyroid tissue
•Struma ovarii- ovarian dermoid tumour contains thyroid tissue
What is the diagnosis in this case?
Graves diesese= diffuse hyperthyroidism - not nodular
What is the diagnosis in this case?
toxic multinodular goitre - see how there are little lumps of overactivity?
What drugs might you use for hyperthyroidism?
•Antithyroid drugs
•
•Radioactive Iodine
•
•Surgery
•
•Beta-blockers
What is the diagnosis in this case?
- 65 year old woman
- Admitted with collapse at home
On admission:
- Comatose
- Temperature 32 C, pulse 35/min regular
- BP 80/50
- Blood glucose 2.9 mmol/L
On examination:
- Loss of outer third eyebrows
- Dry hair, dry skin
- Slow-relaxing ankle jerks
- Neck scar- clue of a thyroidectomy
Patient that doesn’t have a thyroid and has not been taking her thyroid medications- slow relaxation reflexes is major indication of this
*this is an endocrine emergency-
Treatment:
- Intravenous T3/T4
- Supportive care
- Treat precipitant- in this case a kidney infection started this
What is the diagnosis in this case?
- 25 year old intern
- Decreased energy•
- Needs to sleep after work
- Decreased frequency of bowel motions
- FT4 8 low
- TSH 22 high
hypothyroidism •Treatment: T4, 50 microgrammes/day, titrate to normalize TSH
What are the thyroid function levels in hypothyroisim?
•low TT4, TT3
•
•low FT4, FT3
•
•super high TSH
What are the skin symptoms of hypothyroidism?
Skin:
- Increased fluid retention and non-pitting oedema
- Decreased gland secretion
- Decreased surface temperature and pallor
- Brittle hair and nails, hair loss
What are the GI and cardiovascular symptoms of hypothyroidism?
G.I.:
- Weight gain due to decreased BMR- though normally not a significant weight gain
- Constipation
CV:
- Reduced myocardial contractility
- Reduced cardiac output
- Bradycardia
- Increased lipids
- Pericardial effusion
What are the respiratory symptoms of hypothyroidism?
Respiratory:
- Decreased ventilation
- Reversible component in OSA
What are the blood symptoms of hypothyroidism?
Blood:
- Mild anaemia
- Menorrhagiaàanaemia
What are the neuromuscular symptoms of hypothyroidism?
Neuromuscular:
- Psychiatric and neurologic sequelae - ? reduced cerebral blood flow
- Myxoedema coma in the setting of severe trauma or associated illness
- Delayed relaxation phase of deep tendon reflexes
