Endocrinology

Question 1

Hypothryodism

Answer 1

Symptoms
-tired, weight gain, cold peripheries, dry skin, hair loss (many non-specific)
Causes - primary caused by autoimmune - hashimontos, also radioactive iodine, surgery, iodine deficiencey, post partum (increased requirements)
Goitre - can be positive pempbertons sign

Inv - TSH increased, t4 decreased (subclinical - tsh increased, t4 normal --> monitor treat with thyroxine if occurs on more than 2 occasions) 
thyroid antibody positive 
-hyponatraemia
-elevated CK
-elevated serum cholesterol 

Treatment - thyroxine 1.7mcg/kg and 2.0mcg/kg pregnant women (50-150 a day)
Measure TSH every 6 weeks and correct dose

Question 2

Assessing goitre

Answer 2

1.Thyroid status – TSH, FT4, FT32
.Autoimmune status – TPO-Ab positive?
3.If TSH suppressed, scintiscan ? toxic
4.If solitary nodule, USS ? cancer features
5.Cytology by FNA of any suspicious nodules
6.Scan by CT plus Flow-Volume loop if obstructive