Endo - Thyroid Flashcards
What is the characteristic progression of eye signs in Graves disease (NOSPECS)
No signs
Only lid lag/retraction
Soft tissue involved
Proptosis
Extraocular muscles (complex ophthalmoplegia)
Chemosis
Sight loss from optic nerve compression/atrophy
**exposure keratitis
Causes of thyrotoxicosis
- Graves disease (TSH-R antibodies)
- Toxic multinodular goitre (elderly, iodine deficient)
- Toxic adenoma of Thyroid gland (solitary nodule producing T3 + T4 “hot” nodule on isotope scan)
- Ectopic thyroid tissue: ovarian teratoma or metastatic follicular thyroid cancer
- Exogenous iodine or drugs: amiodarone
- subacute deQuervians thyroiditis (post viral, painful goitre)
- TB
NB. If TSH is also high, suggests pituitary source
Differential diagnoses for a goitre
Diffuse, smooth goitre
1. hyperthyroidism (Graves)
2. hypothyroidism (Hashimoto)
3. Subacute deQuervians (tender)
4. physiological
Nodular goitre:
1. adenoma
2. carcinoma
3. multinodular goitre
In addition to systemic signs of hyperthryoidism, which clinical signs are then suggestive of Graves disease as the cause?
- Eye signs: only lid lag and lid retraction indicate hyperthyroidism. Exopthalmos, proptosis, chemosis and ophthalmoplegia are all specific to Graves eye disease
- pretibial myxoedema (oedema above lateral malleoli)
- Thyroid arcopachy (clubbing, painful swelling in fingers and toes, periosteal reaction in limb bones)
What are the possible causes of hypothyroidism?
- Hashimotos (autoimmune anti-TPO antibodies)
- Drugs: amiodarone, lithium, anti-thyroid medication
- Previous radioiodine therapy
- dietary deficient in iodine
What other systemic conditions /signs would you investigate for in thyroid disease?
Hyperthyroid:
- ECG, CXR, Echo for AF/CCF
- DEXA: risk osteoporosis
Hypothyroid:
- autoimmune: addisons (SST), T1DM, vitiligo
- ECG/CXR/echo: effusions, CCF, ischaemia
- lipids: hypercholesterolaemia
Proximal myopathy , carpel tunnel syndrome, ataxia
Macrocytic anaemia
