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Yr 3 Med 2 > Endocrine Workshop > Flashcards

Endocrine Workshop Flashcards

1
Q

What questions would you ask someone with endocrine issues?

What other signs could you see?

A
  • PC and specific symptoms
  • PMH – previous autoimmune conditions, recent viral infections
  • FH – any family history of graves disease etc.
  • Medication history – amiodarone (for arrhythmias + heart problems), levothyroxine, recent contrast media
  • Obstetric history (menopause → increase in sweating, pregnancy → inflammation of thyroid gland)

Signs

  • Essential tremor
  • Thyroid eye disease
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2
Q

Explain the role of the thyroid gland

A
  • Endocrine gland in the neck
  • Secretes 2 main hormones (a lot is protein-bound e.g. albumin)
    1. Thyroxine (T4) - 85%
      1. Majority then converted to T3 peripherly
    2. Triiodothyronine (T3)
  • C-cells secrete calcitonin which control calcium homeostasis
  • Regulates metabolism and impacts heart rate

Iodine converted to iodide by thyroid perioxidase, attaches to tyrosine on thyroglobulin. When TSH stimulates the follicular cells of the thyroid this creates T4 and T3.

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3
Q

Explain how the hypothalamic-pituitary axis works

A
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4
Q

What is thyrotoxicosis?

A
  • Clinical syndrome of excess circulating thyroid hormones (Irrespective of source)
  • Hyperthyroidism is increased thyroid hormone synthesis and secretion specifically from the thyroid gland
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5
Q

What are the effects of thyrotoxicosis?

A
  • Excessive thyroid hormone:
    • increased base metabolic rate
    • increased bone turnover
    • increased gut motility
    • increased cardiac output
    • increased activation of the sympathetic nervous system
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6
Q

What are the causes of thyrotoxicosis?

A
  • Problem with the thyroid gland
  • Problem with the pituitary gland
  • Medication/dietary
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7
Q

Give examples of thyroid problems

A
  • Graves disease
  • Toxic Adenoma/Toxic multi-nodular goitre
  • Thyroiditis (Viral infection/Post partum)
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8
Q

Explain what Graves disease is…

A
  • Most common cause of thyrotoxicosis
  • Autoimmune condition mediated via anti-TSH-Receptor autoantibodies
  • More common in females (Can occur at any age)
  • Strongly associated with other autoimmune conditions (T1DM, Addison’s)

More info

  • Anti-TSH antibodies bind to TSH-receptors on the thyroid gland and stimulate increased production of T3 and T4 from the thyroid gland
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9
Q

What are the symptoms of Graves disease?

A
  • Diffuse goitre (diffuse enlargement of the thyroid gland)
  • Eye disease (e.g. exopthalamus - protruding eye balls, opthalmoplegia, conjunctival oedema, papilloedema, keratopathy - damage to the cornea due to dryness)
  • Dermopathy ( small lesions or spots on the skin - pretibial myxoedema)
  • Acropathy (soft tissue swelling of hands & feet)
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10
Q

What are some important history questions to ask someone with Graves disease (suspected)?

A
  • Family History
  • Past Medical History (Autoimmune disorders)
  • Smoking History
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11
Q

What is a toxic multi-nodular goitre?

A
  • Multiple nodules on the thyroid gland secreting thyroid hormone
  • Nodules non responsive to negative feedback
  • More commonly in older patients (>60 years old)

Doesn’t have typical features of Graves Disease - e.g. eye disease, dermopathy

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12
Q

What is thyroiditis?

A

Thyroiditis - Inflammation of the thyroid gland

  • Sub-acute de Quervain’s thyroiditis – inflammation of the thyroid gland post viral infection
    • Painful neck
    • Hyp_er_thyroid → _Eu_thyroid → Hyp_o_thyroid
  • Post-partum thyroiditis
    • 2-6 months following birth
    • Hyp_er_thyroid → Hyp_o_thyroid
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13
Q

What are differential diagnosis’s of thyroid disease?

A
  • Graves disease
  • Toxic nodular goitre
  • Thyroiditis
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14
Q

What is TSHoma and what can it lead to?

A

Rare pituitary tumour secreting TSH

  • Leading to secondary hyperthyroidism
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15
Q

What medication/dietary supplements can lead to thyroid problems?

A
  • Amiodarone
    • Medication used to treat arrythmias
    • Increases iodine levels thus, increases thyroid hormone production by follicular cells
  • Iodine excess
    • Increased thyroid hormone production
    • E.g. from contrast media for investigations OR excess dietary iodine
  • Levothyroxine (Over-replacement)
    • Can lead to hyperthyroidsm
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16
Q

What are some symptoms of hyperthyroidism?

& other symptoms that are specific to Graves disease

A

Graves specific symptoms

  1. Eye signs – exophthalmos, opthalmoplegia
  2. Pre-tibial myxedema
  3. Thyroid acropachy
17
Q

What investigations would you do on someone who has thyroid problems?

A
  • Thyroid function tests
    • TSH, T4, T3 (good measure FT4, FT3 → FT4 more important because more is made & is convertedto T4 peripherally
  • Antibodies
    • TSH-ab (+ve in 70-100% of Graves & Hashimoto’s) → Graves
    • TPO-ab (+ve in ~70% of Graves & -ve* (or normal) in *Hashimoto’s*) → *Autoimmune
  • Imaging
    • Thyroid uptake scan (raised uptake in Graves) OR (reduced uptake → thyroiditis,hashimoto’s & excess iodine intake)
    • Thyroid USS
18
Q

What is the management of thyroid conditions?

A
  • Symptom control
    • B blockers
  • Anti-thyroid drugs (ATD)
    • Carbimazole, propylthiouracil
    • ‘Block and replace’ → give anti-thyroid drugs to completely suppress natural thyroid hormone production then replace with levothyroxine.
    • or ‘Dose titration’ → give sufficient amount of ATD to suppress thyroid hormone back to normal levels. Only option in pregnancy
  • Surgery
    • Used for relapsed Graves
    • Needs to be euthyroid prior to surgery otherwise thyroid storm
    • Complications:
      • Hypothyroidism
      • Surgical complications
  • Radioiodine therapy
    • Taken as drink leads to destruction of gland
    • NOT given in pregnancy, children, breast-feeding women & avoid kids & pregnant women
    • Can lead to hypothyroidism
19
Q

What is a thyroid storm? (symptoms & risk factors & treatment)

A
  • Rare but potentially life threatening complication of thyrotoxicosis
  • High mortality
  • Features:
    • Altered mental status
    • Tachycardia/Arrthymias
    • Fever
    • Nausea & vomiting, diarrhoea
    • Abdo pain
    • Seizures
  • Risk Factors:
    • Acute infection
    • Postpartum
    • Post surgery or RAI
    • Withdrawal of ATDs
  • Treatment:
    • B blockers, Steroids and anti-thyroid drugs
20
Q

What is hypothyroidism? (& what are the types?)

A
  • Lack of thyroid hormone
  • Reduced metabolic rate, reduced gut motility, reduced sympathetic nerve activity
  • Types
    • Primary hypothyroidism
      • Thyroid problem
    • Secondary hypothyroidism
      • Pituitary/hypothalamic problem
21
Q

What is primary hypothyroidism? (& causes)

A
  • Autoimmune hypothyroidism (thyroid problem) →Hashimoto’s thyroiditis
  • Iodine deficiency
  • Iatrogenic – Surgical treatment, radioiodine therapy, radiotherapy → with cancer in neck
  • Drugs → amiodarone, lithium
  • Thyroiditis
22
Q

What is Hashimoto’s disease?

A
  • Autoimmune disorder → Destruction of the thyroid gland
  • Much more common in females
  • Goitre present
  • Anti-TPO and Anti-Tg abs present
  • Linked to other autoimmune conditions
23
Q

What are the symptoms of HYPOthyroidism?

A

Often insidious and non-specific

24
Q

What is the management of _hypo_thyroidism?

A
  • Levothyroxine
    • Monitor TFTs and titrate dose according to TSH
    • Caution in elderly and heart failure
    • Need to wait weeks after dose changes to repeat blood tests to assess TSH
25
Q

What would TSH, T3, T4 be in: (blood test)

  1. Primary hypothyroidism
  2. Secondary hypothyroidism
  3. Sub-clinical hypothyroidism
  4. Primary hyperthyroidism
  5. Secondary hyperthyroidism
  6. Sub-clinical hyperthyroidism
A
26
Q

What is the most common cause of hyperthyroidism?

A)Hashimoto’s

B)Multi-nodular Goitre

C)Graves Disease

D) Thyroid cancer

A

C) Graves disease

27
Q

Which antibodies are most specific for graves disease?

A)TSH antibodies

B)TTG antibodies

C)TPO antibodies

D)Anti-CCP antibodies

A

A)TSH antibodies

28
Q

A 37 year old lady presents to see you with heavy periods, weight gain and low mood. Which blood test is likely to be low?

A)TSH

B)Testosterone

C)T4

D)Cortisol

A

A)TSH

29
Q

A 50 year old gentleman presents to the GP with weight gain, heat intolerance and insomnia. You suspect he was primary hypothyroidism. Which blood test results correspond to this?
A)High TSH, High T3/T4

B)Low TSH, Normal T3/T4

C)Low TSH, Low T3, T4

D)High TSH, Low T3/T4

A

D)High TSH, Low T3/T4

30
Q

What do the blood tests suggest?

TSH - 9 ( 0.4 - 5.0)

T4 - 10 ( 9 - 22)

T3 - 4 ( 3.5 – 7.8)

A)Hyperthyroidism

B)Hypothyroidism

C)Sub-clinical hypothyroidism

D)Sub-clinical hyperthyroidism

A

C)Sub-clinical hypothyroidism

31
Q

A 42-year-old woman presents to her GP complaining of increased anxiety and palpitations. She has noticed excessive sweating and has lost weight recently.

TSH: 14 mU/L (0.4-4.0 mU/L)

T4: 29 mU/L (9-24 pmol/L)

Which additional symptom is she likely to complain of?

A) Headache relieved by lying down

B) Increase in shoe size

C) Loss of the outer 3rd of the eyebrows

D) Difficulty driving due to reduced peripheral vision

A

D) Difficulty driving due to reduced peripheral vision

32
Q

What is acromegaly?

A
  • Excessive growth hormone secretion
  • Usually caused by a pituitary adenoma
  • Insidious onset and slow progression
    • Delayed diagnosis
33
Q

Draw a flow diagram of growth hormone on the body

A
34
Q

What are the symptoms and signs of acromegaly?

A

Symptoms

  • Sweating
  • Change in shoe, ring size
  • Change in facial features
  • Headaches
  • Lethargy
  • Joint pains
  • Galactorrhoea, amenorrhoea

Signs

  • Coarse facial features
  • Macroglossia
  • Deep voice
  • Spade like hands, enlarged feet, OA
  • Carpal tunnel syndrome
  • Goitre and organomegaly

UP to ⅓ patients will have symptoms of _hyperprolactinaemia_ due to adenoma also secreting PROLACTIN

35
Q

What investigations to do with someone with acromegaly?

A
  • IGF-1
  • Prolonged oral glucose tolerance test
    • High levels of glucose should suppress GH release
    • Fails to happen in acromegaly
  • MRI pituitary

GH release SHOULD be inhibited by glucose

36
Q

What is the management of someone with acromegaly?

A
  • Medical
    • Somatostatin analogues (Octreotide - inhibits GH release)
    • Dopamine agonists (Bromocriptine, cabergoline) → less effective at suppressing GH release
    • GH receptor antagonists (Pegvisomant)
  • Surgical
    • Surgical removal of adenoma is the treatment of choice
37
Q

What are the complications of acromegaly?

A
  • Hypertension
  • Impaired glucose tolerance and T2DM
  • Obstructive sleep apnoea
  • IHD and heart failure
  • Increased incidence of thyroid and colon cancer (common screening provided)
38
Q

What are some rarer causes of hypertension?

A
  • Conn’s syndrome
  • Phaechromocytoma
  • Cushing’s syndrome
  • Renal artery stenosis

Yr 3 Med 2 (8 decks)

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