Endocrinology Flashcards
thyrotoxicosis
the clinical state associated with excess thyroid hormone activity, usually due to inappropriately high-circulating thyroid hormones. The clinical presentation varies, ranging from asymptomatic to life-threatening thyroid storm.
thyrotoxicosis presentation
hyper active
resting tremor
NO tenderness to thyroid (goiter is smooth but no actual inflammation- otherwise itd be sub acute thyroiditis)
heat intolerance, palpitations, anxiety, fatigue, weight loss, muscle weakness, and, in women, irregular menses.
tremor, tachycardia, lid lag, and warm moist skin.
Graves’ disease
autoimmune disease attack on thyroid
antibodies produced against thyroid and eyes
proptosis
symptom of graves’ disease
eyes pushed forwards
lid retracted
can lead to loss of vision
pressure on optic nerves
paralysis of eye muscle
double vision
CRP result
marker for inflammation
normal for Graves’
high for thyroiditis
T3 , T4 and TSH in Graves’
higher production of T3 in circulation
high T4
LOWER TSH
hyperthyroidism and symptom
overactive thyroid
aka thyrotoxicosis
increased activity of the sympathetic nervous system
increased activity of muscle that controls the upper lid
upper lids retracted
lid lag
thyroid physiology
hypothalamus releases TRH
anterior pituitary releases TSH
T3 and T4 released in thyroid in negative feedback loop
inhibits TSH or TRH
thyrotoxicosis due to Graves’ disease
immune system producing autoimmune antibodies directed against TSH receptor
mimics TSH but constant stimulation
increases synthesis of thyroid hormones
leads to goiter formation
runs in families
female side
symptoms of hyperthyroidism
hyperactivity
heat intolerance
fatigue
weight loss
(despite always hungry)
diarrhoea
tachycardia
tremor
goiter
warm, moist skin
lid lag
causes of thyrotoxicosis
graves’ (TSH receptor stimulating antibody)
toxic nodule
toxic multinodular goitre
factitious thyrotoxicosis (external supplementation)
thyrotoxicosis associated with subacute thyroiditis is diff
detection of thyrotoxicosis
TSH receptor antibody
positive for graves
negative use other scans/goiter
treatment of Graves’
1) peripheral adrenergic blockade:
propranolol (BB)
blocks tachycardia and tremor
diltiazem (calcium antagonist) if asthma
2) inhibit hormone synthesis of TPO thyroid peroxidase:
CBZ or PTU
risk of liver problems
3) removal of thyroid:
thyroxine for life
myxoedema
swelling of skin
excess deposition of glycans
hypothyroidism
things to look for in blood test
cortisol level too high = cushings
too low = addisons
TSH raised
low T4 T3
hypothyroidism causes
subclinical disease -> myxoedema coma
primary disease most common:
autoimmune
latrogenic (caused by medicine)
elderly obese females
radiotherapy damaging thyroid for throat cancer
hypothyroidism symptoms
myxoedema
nervous system:
forgetfulness, slow
carpal tunnel
cardiovascular:
bradycardia
decreased cardiac output
dependent oedema
Gastrointestinal:
constipation
ascitic fluid
renal:
hyponatremia
decreased glomerular filtration
reduced excretion of water
pulmonary:
respiratory compromise with hyperventilation
airway obstruction
musculoskeletal:
muscle cramps
myopathy
anaemia:
skin and hair:
loss of lateral eyebrows
dry cool skin
puffy face
metabolism:
hypothermia
intolerance to cold
weight gain
reproductive system:
heavy periods
diagnosis of hypothyroidism
high TSH and low T4 = primary hypothyroidism
low/normal TSH and low T4 = secondary
pituitary disease
critically ill
myxoedema treatment
levothyroxine
check cortisol level first
lower dose if old
hypothyroidism may be protecting them from heart failure due to slowed metabolic rate
hyperpigmentation
caused by ACTH
Addison’s disease
primary adrenal insufficiency
lab results suggesting adrenal insufficiency
low na high K = aldosterone deficiency
less reabsorption of Na, more excretion of K
low cortisol
high ACTH to compensate
adrenal insufficiency
an absolute or relative deficiency of adrenal hormones
cortisol
aldosterone
androgen
cortisol
glucocorticoid
Cortisol is a steroid hormone that is produced by your 2 adrenal glands, which sit on top of each kidney. When you are stressed, increased cortisol is released into your bloodstream
immune response
stress factors cause adrenal cortex to release cortisol
aldosterone
Aldosterone (ALD) is a hormone that helps regulate your blood pressure by managing the levels of sodium (salt) and potassium in your blood and impacting blood volume.
retains Na, loses K
