Endocrine Flashcards
Clinical features of hypothyroidism
- lethargy
- weight gain
- cold intolerance
- constipation
- hair loss
- dry skin
- depression
- bradycardia
- memory impairment
- menorrhagia
Clinical features of hyperthyroidism
- tachycardia
- palpitations (AF)
- hyperactivity
- weight loss w/ increased appetite
- heat intolerance
- sweating
- diarrhoea
- fine tremor
- hyper-reflexia
- goitre
- palmar erythema
- onycholysis (nail detachment)
- muscle weakness + wasting
- oligomenorrhoea/amenorrhoea
Clinical features of Grave’s disease
- exophthalmos/proptosis
- chemosis (conjunctival swelling)
- diffuse symmetrical goitre
- pretibial myxoedema (rare)
- other autoimmune conditions
- thyroid bruit
What would the TFTs show for someone with primary hypothyroidism?
- raised TSH (due to absence of negative feedback)
- low T4 (due to thyroid’s inability to produce enough T4)
Causes of primary hypothyroidism?
- autoimmune thyroiditis (50%)
- iodine deficiency or excess
- thyroidectomy
- radioactive iodine therapy
- external radiotherapy
- drugs
- thyroid agenesis or dysgenesis
What would the TFTs show for someone with secondary hypothyroidism?
- normal/low TSH (due to lack of production)
- low T4 (due to absence pf any positive feedback from TSH)
Causes of secondary hypothyroidism?
Pituitary causes:
- pituitary adenoma (most common)
- pituitary surgery/radiotherapy which damages pituitary tissue
Hypothalamic causes:
- hypothalamic or suprasellar tumour
- surgery/radiotherapy which damages hypothalamic tissue
What would the TFTs show for someone with primary hyperthyroidism?
- raised T3/T4 (due to excessive production)
- low TSH (due to negative feedback loops)
Causes of primary hyperthyroidism?
- Grave’s disease (75% of cases)
- toxic multi nodular goitre
- toxic adenoma
- iodine-induced (rare)
- trophoblastic tumour (v. rare)
What would the TFTs show for someone with secondary hyperthyroidism?
- raised T3/T4 (due to excessive production driven by raised TSH)
- raised TSH (due to excessive production)
Causes of secondary hyperthyroidism?
- TSH-secreting tumour
- Chorionic-gonadotropin secreting tumours (hCG secreting)
- thyroid hormone resistance - TSH is resistant to T3/T4 negative feedback loop
How would you palpate the foot in a diabetic foot exam?
- check for temperature
- check for capillary refill
- check pulses: popliteal pulse, posterior tibial pulse, dorsals pedis pulse
How would you check sensation in the foot in a diabetic foot exam?
- monofilament - (control), pulp of hallux, pulp of third digit, MTP joints 1, 3 and 5
- vibration using 128Hz tuning fork - MTP of big toe, ankle joint, knee joint
- check for proprioception using most distal joint
- ankle jerk reflex (Achille’s tendon)
How would you inspect/observe the foot in a diabetic foot exam?
- check lower limbs for relevant pathology eg peripheral cyanosis or venous ulcers
- assess gait eg foot drop, walking speed ad foot stance
- check patients footwear eg uneven wear and tear
- check any walking aides
How would you complete a diabetic foot exam?
- check bedside capillary BM
- lower limb near exam
- peripheral arterial exam
- foot care advice
- calculation of DF risk using assessment tool
