Endo Flashcards
hyperthyroidism signs and symptoms
tremor
anxiety
palpitations
heat intolerance
diarrhoea
oligomenorrhoea
causes of hyperthyroidism
Grave’s disease
toxic multinodular goitre
thyroiditis
drugs (i.e amiodarone)
management of hyperthyroidism
propanolol
carbimazole (TPO inhibitor)
radioiodine
which antibodies are associated with Grave’s disease
anti-TSH receptor antibodies
how does propanolol work to treat hyperthyroidsm
used to block b receptors as in hyperthyroidism T4/3 excess leads to increased expression of b-adrenergic receptors thus increased sympathetic tone
antibodies associated with Hashimoto’s thyroiditis
anti-TPO antibodies
hypothyroidism signs and symptoms
lethargy
cold intolerance
weight gain
constipation
menorrhagia
reduced deep tendon reflexes
causes of hypothyroidism
Hashimoto’s thyroiditis
subacute (de Quervain’s) thyroiditis
drugs (i.e. amiodarone, lithium)
iodine deficiency
hypothyroidism mx
levothyroxine
thyroid eye disease features
bilateral exophthalmos
diplopia
conjunctival oedema (chemosis)
ophthalmalgia
exposure keropathy
optic neuropathy
lid lag and retraction (caused by sympathetic hyperactivity of muscle in upper eyelid)
thyroid eye disease pathophysiology
anti TSH receptor antibodies bind to TSH receptor behind eye
Grave’s disease niche signs
thyroid eye disease
pretibial myxoedema
thyroid acropachy
thyroid cancer features
non-functional, painless, rapidly growing
solitary, irregular (nodular) shape
hoarse voice (recurrent laryngeal nerve)
dysphagia
haemoptysis
airway obstruction
cervical lymphadenopathy
thyroid cancer Ix
fine needle aspiration biopsy with USS, CT/PET, thyroid scan
TFTs may be useful to exclude benign (functional) nodules
types of thyroid cancer
papillary carcinoma (70%) (female, childhood radiation exposure)
follicular carcinoma (20%) (female, low iodine intake)
- Hurthle cell carcinoma is a variant
medullary carcinoma (5%) - associated with MEN 2A and MEN 2B
anaplastic carcinoma (1%)
lymphoma (rare)
what would biopsy show for thyroid follicular carcinoma
neoplastic papillae + psammoma bodies + ground glass nuclei
which cells are affected in thyroid follicular carcinoma
follicular cells
which cells are affected in thyroid papillary carcinoma
follicular cells
which cells are affected in thyroid medullary carcinoma
c-cells
produce calcitonin which is measured in the blood
typical age onset for MEN1
teens and 20s
typical age onset MEN2
any age but mostly later in life (50-70)
how is MEN1 inherited
autosomal dominant inheritance of an inactivating mutation of the tumour suppressor gene MEN1
organs affected with MEN1
remember 3 Ps
Parathyroid, pancreatic, pituitary
others (eg. carcinoid, adrenal, thyroid)
MEN1 signs and symptoms
varies depending on organ affected
hypercalcaemia (due to hyperPTH from parathyroid adenoma/hyperplasia)
-stones, moans, groans
peptic ulcer (caused by too much gastrin)
insulinomas, glucagonomas, gastrinomas (gastrinomas most likely to be functional)
pituitary tumours mainly secrete prolactin
MEN1 Ix
check PTH and Ca for primary hyperthyroidism
elevated gastrin from gastrinoma
hypoglycaemia and raised c-peptide for insulinoma
hyperglycaemia and raised glucagon for glucagonoma
stage with CT/MRI and DEXA for hyper PTH
how is MEN2 inherited
autosomal dominant inheritance of activating mutation of the proto-oncogene, RET
how does MEN2A present
presents with parathyroid involvement so hypercalcaemia symptoms and phaeochromocytoma (sweating, palpitations, hypertension, headaches)
MEN1 Ix
check PTH and Ca for primary hyperthyroidism
elevated gastrin from gastrinoma
hypoglycaemia and raised c-peptide for insulinoma
hyperglycaemia and raised glucagon for glucagonoma
stage with CT/MRI and DEXA for hyper PTH
genetics
