Endocrine diseases

Question 1

symptoms and signs of hypothyroidism?

Answer 1

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

Question 2

differentials for hypothyroidism

Answer 2

depression
anaemia
sleep disorders

Question 3

differentials for hyperthyroidism?

Answer 3

malignancy
addison’s disease?
anxiety, panic attacks
cocaine/amphetamine misuse?

Question 4

management of hyperthyroidism?

Answer 4

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

Question 5

complications of thyroidectomy?

Answer 5

hypoparathyrodisim- hypocalcaemia
haemorrhage
vocal cord paralysis- on ligating arteries, the recurrent laryngeal nerves supplying the intrinsic muscles of the VCs are damaged.

Question 6

symptoms and signs of hyperthyroidism?

Answer 6

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

Question 7

prognosis in hyperthyroidism?

Answer 7

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

Question 8

explain hyperthyroidism

Answer 8

1

Question 9

explain hypothyroidism

Answer 9

1

Question 10

management of hypothyroidism?

Answer 10

oral thyroxine, given as levothyroxine

Question 11

explain type 1 diabetes mellitus

Answer 11

1

Question 12

explain type 2 diabetes mellitus

Answer 12

1

Question 13

possible complications of hyperthyroidism if left untreated?

Answer 13

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.

Question 14

most common cause of hyperthyroidism?

Answer 14

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

Question 15

what exactly happens in Grave’s disease?

Answer 15

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.

Question 16

example of a drug which may cause hyperthyroidism?

Answer 16

amiodarone- anti-arrhythmic drug-K+ channel blocker

Question 17

who gets hyperthyroidism?

Answer 17

more common in women, any age

may be FH e.g. with grave’s disease= AI, or FH of other AI conditions.

Question 18

-ve feedback mechanism in hyperthyroidism to explain blood results?

Answer 18

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.

Question 19

why might my symptoms not disappear straight away if I’m given carbimazole for tment of hyperthyroidism?

Answer 19

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.

Question 20

what should patients be made aware of if taking carbimazole?

Answer 20

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.

Question 21

how does radio-iodine work in treating hyperthyroidism?

Answer 21

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.

Question 22

general advice when treating hyperthyroidism?

Answer 22

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

Question 23

complications of hypothyroidism?

Answer 23

heart disease as increased lipids
complications in pregnancy if pregnant
coma

Question 24

most common cause in UK for hypothyroidism?

Answer 24

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

Question 25

most common cause worldwide for hypothyroidism?

Answer 25

Fe deficiency