Endocrinology Flashcards
Describe Hashimoto’s Thyroiditis
Autoimmune condition against thyroid tissue/follicles
initially causes a transient hyperthyroidism as the damaged follicles release hormones
Eventually as more become damaged it leads to hypothyroidism (with a PAINLESS goitre due to abnormal/scarred tissue)
How to test for Hashimotos Thyroiditis
Initially hyper thyroid, later hypo thyroid
anti- thyroid peroxidase
anti- thyroglobulin
Chain of thyroid hormones
TRH >TSH > Thyroglobulin > T4/T3 (iodine containing)
Describe Graves disease
Auto immune disorder which inappropriately stimulates thyroid follicle cells > excess hormone production.
Thyroid stimulating immunoglobulin acts like TSH and binds to TSH receptor
Can also bind to fibroblasts in the eyes cause opthalmologic symptoms
Graves disease symptoms
Hyperthyroid Symptoms: WL, tremor, tachycardia etc
Eye Symptoms: exopthalmus, weakened eye muscles, damaged cornea
Pretibial myoxedema
How to test for Graves disease
Low TSH, high T3/T4
TSH receptor Stimulating antibody
Anti-thyroglobulin and anti-thyroid peroxidase may also be positive
What is euthyroid sick syndrome
Normal thyroid gland, but low hormone levels (especially T3) usually due to starvation or illness
normal -low TSH
Normal - Low T4
Low T3
transient, as the hormone levels drop but the gland itself is fine
doesn’t usually need treatment
Graves disease treatment, and what do you need to remember to tell the pt about with this medication
Carbimazole (ineffective for thyroiditis) -
- side effects include agranulocytosis, hepatitis, arthritis, rash
Beta blocker (propanolol) may also aid symptoms
What is subacute / de quervains thyroiditis
When you have a viral URTI and the virus also attacks thyroid tissue and triggers the immune system
Thyroid tissue/follicles are destroyed by the virus and our own immune cells (which form granulomas) releasing hormones (hyperthyroid state which later normalises)
Large painful goitre
Treatment for sub acute /de quervains thyroiditis
Supportive
Usually self limiting <6-8 weeks
as we recover from the virus we stop attacking the thyroid and the gland slowly repairs itself
Hyperthyroid state usually normalises (without becoming hypothyroid)
How to test for sub acute /dequervains thyroiditis
No antibodies
low TSH, high T3/T4
High CRP/ESR
Recent viral URTI
what is toxic multinodular goitre
iodine deficiency causes excess TSH > formation of nodules over many years
TSH mutation triggers non toxic to switch to toxic
symptoms of toxic multinodular goitre
- Hyperthyroid symtpoms
- Compression symptoms
- SVC syndrome
- Airway compression
- Nerve compression: recurrent laryngeal nerve causing hoarse voice
What causes cushings syndrome
High cortisol levels
Endogenous
- Pituitary adenoma (Cushing disease) due to excess ACTH
- Adrenal adenomas/carcinomas
- SCLC (tumours that secrete ACTH)
Exogenous
- Steroids as it acts like cortisol (this can cause atrophy of the adrenal glands as the body tries to shut down this feedback cycle)
Symptoms of Cushings Syndrome
- Muscle wasting and thin extremeties
- Central adiposity
- Moon Facies and buffalo hump
- Thin skin and easy bruising , abdominal striae
- Osteoporosis
- Hyperglycaemia > T2DM
- HTN
- weight gain
- Acne
- poor wound healing/infections
- ammennhorrea
- Psychiatric issues
