Endocrinology Flashcards
Graves disease
autoimmune disease attacking the thyroid
defining factor of graves disease
eyes pushed forward, proptosis
what mechanism leads to tsh being low
negative feedback from elevated thyroid hormones
main hormones produced by thyroid
t4 mainly, some t3
thyrotoxicosis due to Graves disease
stimulating receptor binds to tsh
goiter - enlarged thyroid
hyperactive thyroid
symptoms of hyperthyroidism
hyperactivity
heat intolerance
palpitations
fatigue
weight loss
diarrhoea
polyuria
oligomenorrhea - abnormal periods (stop)
signs of hyperthyroidism
tachycardia/ A fib
tremor
goiter
warm, moist skin
muscle weakness
lid retraction
gynaecomastia
common causes of thyrotoxicosis
graves disease
toxic multinodular goitre
toxic nodule
factitious thyrotoxicosis - taking thyroid themselves
thyrotoxicosis associated with subacute thyroiditis
treatment of graves
peripheral adrenergic blockade e.g., propanolol (beta blocker)
diltiazem if asthma - beta blocker will cause bronchoconstriction
inhibit hormone synthesis e.g., carbimazole or propylthiouracil (in pregnant or trying to get pregnant)
why is it important to check cortisol in hypothyroid patients
addisons disease undiagnosed, give them thyroxin would precipitate an adrenal crisis
advantage of short acting drugs
act quickly
disadvantage short acting drugs
keep giving them
advantage of T3
can give it IV so dont need to rely on gut for absorption
hypothyroidism range
sub clinical to myxedema coma
symptoms of hypothyroidism
NERVOUS SYSTEM - carpal tunnel, paraesthia, ataxia, forgetfulness
CARDIOVASCULAR - bradycardia, dec CO, pericardial effusion, dependent oedema, reduced voltage on ECG and flat T waves
GASTROINTESTINAL - contripation, pernicious anemia, ascites
RENAL - reduced excretion of water load - hyponatremia, dec glomerular filtration
PULMONARY - pleural effusion, hypoxia and hypercapnia response dec, airway obstruction
MUSCULOSKELETAL - arthralgia, muscle cramps, joint effusions, CK elevated
ANEMIA - noromochromic normocytic
SKIN AND HAIR - loss of lateral eyebrows, dry cool skin, orange skin
REPRODUCTIVE - heavy periods, hyperploactinemia
METABOLISM - hypothermia, intolerance to cold, inc cholesterol and triglycerides, weight gain
diagnosis of hypothyroidism
high tsh low free t4
hypothyroidism treatment
levothyroxine
lower dose if elderly or IHD to avoid cardiac event in known heart condition
adrenal insufficiency
absolute or relative deficiency of adrenal hormones - cortisol, aldosterone, androgens
role of cortisol
glucocorticoid produced in relation to stress to make more energy available to the body
has an immunosuppressant effect
important for BP regulation
role of aldosterone
BP regulation
vascular volume
electrolytes
difference between primary and secondary adrenal insufficiency
- ACTH - primary high, secondary low
- PIGMENTATION - primary yes, secondary no
- ALDOSTERONE - primary low, secondary normal
- K - primary high, secondary low
- VOLEMIA - primary hypo, secondary euvo
Addison’s disease symptoms
weakness
pigmentation of skin
weight loss
anorexia, vomiting , nausea
hypotension
pigmentation of mucous membranes
abdominal pain
salt craving
diarrhoea
constipation
syncope
vitiligo
causes of primary adrenal insufficiency
autoimmune
infectious
infiltrative - neoplasm
latrogenic - post adrenalectomy
haemhorrage - due to infections e.g., septicaemia
CAH
congenital unresponsiveness to ACTH
causes of secondary adrenal insufficiency
exogenous glucocorticoids
pituitary insufficiency
sheehan syndrome
hypothalamic insufficiency
head trauma
precipitants of adrenal crisis
post surgical
injury
migraines
pregnancy, labour
bereavement
vomiting
adrenal crisis
hypotension, hypovolemic, hypoNa, hyperK, hyperCa, hypoglycaemia
adrenal crisis treatment
fluid resuscitate 0.9% saline for hypotension
correct hyperkalaemia
hypoglycaemia - 5-10% glucose
correct hormone deficiency - hydrocortisone
treat precipitating factor
prevention of adrenal crisis
acute illness - double dose
severe illness - hydrocortisone injection
