Endocrine diseases Flashcards
symptoms and signs of hypothyroidism?
cold intolerance weight gain, but loss of appetite constipation- loss of thyroid hormones necessary for receptor synthesis in intestines to mediate movements?* tired, lethargic depression alopecia flaky and dry skin poor memory, difficulty concentrating deep hoarse voice menorrhagia, and later oligomenorrhea or amenorrhoea, = may also be presentation of Fe deficiency anaemia. impaired hearing as fluid in middle ear reduced libido bradycardia
differentials for hypothyroidism
depression
anaemia
sleep disorders
differentials for hyperthyroidism?
malignancy
addison’s disease?
anxiety, panic attacks
cocaine/amphetamine misuse?
management of hyperthyroidism?
carbimazole- thyroid perioxidase inhibitor, monitor with thyroid function tests every month. remission usually achieved at 18-24 mnths. but must monitor for recurrence.
beta blockers- manage symptoms- tachycardia
radioactive-iodine
subtotal or near total thyroidectomy
want to avoid drug induced hypothyroidism- RISK
complications of thyroidectomy?
hypoparathyrodisim- hypocalcaemia
haemorrhage
vocal cord paralysis- on ligating arteries, the recurrent laryngeal nerves supplying the intrinsic muscles of the VCs are damaged.
symptoms and signs of hyperthyroidism?
heat intolerance tachycardia weight loss, but increased appetite irritability fatigue dehydration- related to diarrhoea tremor- present all the time, doesn't go away on doing activities oligomenorrhea or amenorrhea palmar erythema brisk reflexes
symptoms develop slowly over several wks, and worsen over time
prognosis in hyperthyroidism?
Hyperthyroidism is characterised by relapses and remittances. Surgical treatment and radioactive iodine can both lead to hypothyroidism and thus close follow-up with TFTs is required.
Spontaneous remission is seen in <10% and may not persist.
There is a 3 x increased risk of death from osteoporotic fracture and 1.3 x increased risk of death from cardiovascular disease and stroke in untreated hyperthyroidism. The risk of cerebrovascular disease is also significant in younger adults.
Long-term follow-up studies have shown increased mortality from cardiovascular and cerebrovascular disease in those with a past history of treatment with radio-iodine for overt hyperthyroidism
explain hyperthyroidism
1
explain hypothyroidism
1
management of hypothyroidism?
oral thyroxine, given as levothyroxine
explain type 1 diabetes mellitus
1
explain type 2 diabetes mellitus
1
possible complications of hyperthyroidism if left untreated?
CVS problems e.g. atrial fibrillation, cardiomyopathy, angina and heart failure
osteoporosis
complications in pregnancy if pregnant
outlook good with tment, most symptoms and risks of complications go away.
most common cause of hyperthyroidism?
Grave’s disease- tends to occur in women aged between 20 and 50 yrs.
often FH of condition
may be other AI disease in family e.g. type 1 DM, RA, MG
what exactly happens in Grave’s disease?
In autoimmune diseases, the immune system makes antibodies- proteins that normally protect the body against infectious agents e.g. bacteria and viruses, against normal tissues of the body. If you have Graves’ disease, you make antibodies that attach to the thyroid gland. These stimulate the thyroid to make lots of the thyroid hormone thyroxine. 2 thyroid hormones in body with same function controlling how fast the body’s functions take place. Thyroxine (T4) can be converted to the other thyroid hormone tri-iodothyronine- T3. With too many of these hormones being produced, everything in the body speeds up. It is thought that something triggers the immune system to make these antibodies. The trigger is not known.
example of a drug which may cause hyperthyroidism?
amiodarone- anti-arrhythmic drug-K+ channel blocker
who gets hyperthyroidism?
more common in women, any age
may be FH e.g. with grave’s disease= AI, or FH of other AI conditions.
-ve feedback mechanism in hyperthyroidism to explain blood results?
looking for level of thyroxine in blood= high will be hyperthyroidism, but also measure thyroid stimulating hormone (TSH). all hormones travel in blood to tell different areas of body what to do. thyroid stimulating hormone released from a gland in the brain= pituitary, and tells the thyroid gland to produce thyroid hormones. if lots of thyroid hormones, we don’t want the thyroid gland to keep being told to produce more, so the thyroid hormones themselves can travel in the blood to the pituitary and tell it to stop releasing TSH, hence this will be low in the blood in hyperthyroidism.
why might my symptoms not disappear straight away if I’m given carbimazole for tment of hyperthyroidism?
carbimazole stops thyroid hormones being produced, but it doesn’t have an effect on the thyroid hormones that have already been produced in the body before you give the drug, so may take 4-8wks for thyroxine to normalise.
may take drug for 1yr to 1yr and half, in around half of people symptoms will have now disappeared and drug can be stopped, may be given again in future if symptoms come back.
what should patients be made aware of if taking carbimazole?
can increase your risk of infection by affecting wbc which fight infection, so should see dr for a blood test if symptoms of fever, sore throat, mouth ulcers develop, and stop taking the medication.
another drug= propylthiouracil can be given instead if pregnant or breast-feeding.
how does radio-iodine work in treating hyperthyroidism?
take a drink or swallow a capsule, which contains radioactive iodine. Iodine mainly needed in body to make thyroid hormone thyroxine, so radioactive iodine given will be taken up by the thyroid gland as the gland wants iodine, but as radioactive, it will stop part of the thyroid gland from working normally, so unable to produce thyroid hormones.
low dose of radioactivity to rest of body, so not dangerous.
general advice when treating hyperthyroidism?
must be aware of infection symptoms with carbimazole
minimise contact with people for few wks after stopping radio-iodine to minimse radioactivity affecting other people, especially children and pregnant women.
should stop smoking-can make eye problems worse
may have to be given thyroid hormone replacement therapy as difficult to get balance right between lowering thyroid hormones but not lowering them too much that functions of body slow down completely producing other symptoms.
may be given a beta blocker initally while other tments taking time to work, to reduce tremor, feeling of heart pumping hard, and sweating.
regular blood tests, usually 1 every yr, to check right levels of thyroid hormones in blood
complications of hypothyroidism?
heart disease as increased lipids
complications in pregnancy if pregnant
coma
most common cause in UK for hypothyroidism?
Autoimmune thyroiditis - the common cause in the UK
The immune system which normally makes antibodies to fight infection now makes antibodies against certain tissues of your body. With a goitre (gland enlarged producing neck swelling), then known as Hashimoto’s.
The thyroid gland is then not able to make enough thyroxine, and hypothyroidism gradually develops.
Autoimmune thyroiditis is more common than usual in people with:
A family history of hypothyroidism caused by autoimmune thyroiditis.
Down’s syndrom
Turner syndrome. Again, an annual blood test to screen for hypothyroidism is usually advised for people with this condition.
An enlarged thyroid gland (diffuse goitre).
A past history of Graves’ disease, or thyroiditis following childbirth.
A personal or family history of other autoimmune disorders - for example: vitiligo, pernicious anaemia, Addison’s disease, type 1 diabetes, premature ovarian failure, coeliac disease, Sjögren’s syndrome.
Also, people with autoimmune thyroiditis have a small increased risk of developing other autoimmune conditions such as vitiligo, pernicious anaemia, etc
most common cause worldwide for hypothyroidism?
Fe deficiency
