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Week 30: Tired All The Time 2 > general > Flashcards

general Flashcards

1
Q

define hyperthyroidism

A

excess of circulating thyroid hormones (thyrotoxicosis), which are produced by an overactive thyroid gland

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2
Q

describe the difference between primary (most common), secondary hyperthyroidism (rare)

A

primary = cause is in the thyroid gland itself e.g. Graves disease (TSH receptor antibodies) or toxic thyroid nodules or malignancy

secondary = cause is elsewhere e.g. the abnormal stimulation of a normal thyroid gland by TSH-secreting pituitary tumour

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3
Q

describe thyrotoxicosis without hyperthyroidism

A

thyrotoxicosis without thyroid gland over-activity e.g. from drugs (levothyroxine) or thyroiditis

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4
Q

how is the amount of thyroid hormone in the bloodstream controlled?

A

negative feedback

stimulus (e.g. low levels of thyroid hormones in the blood) needed to send signal to hypothalamus –> secretes TRH –> ant. pituitary –> secretes TSH –> via bloodstream to thyroid gland –> thyroid hormones into bloodstream. if there are normal levels of thyroid hormones in the blood –> negative feedback to the ant. pituitary to stop secretion of TSH (also some -ve feedback onto hypothalamus)

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5
Q

list common signs/symptoms of hyper and hypo-thyroidism

A

hyperthyroidism:

  • weight loss
  • tremor
  • heat intolerance
  • palpitations
  • sweating
  • peripheral vasodilation
  • tachycardia

hypothyroidism:

  • constipation
  • weight gain
  • dry hair and skin
  • cold intolerance
  • slow-relaxing reflexes
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6
Q

most cases of primary hyperthyroidism are attributed to an autoimmune mechanism. However, some cases are caused by malignancy. describe the characteristics of a thyroid tumour and the potential risk factors for malignancy

A
  • large, rapidly growing hard/fixed mass. usually associated with lymphedema in the neck
  • risk factors = FHx of malignancy, Hx of ionising radiation in the head/neck, male, age <20 or >60
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7
Q

what is the first step of diagnosis hyperthyroidism? What other investigation may be necessary?

A
  • 1st bloods

- ultrasound scan if any lumps identified

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8
Q

thyroid storm (thyrotoxic crisis) is a complication of hyperthyroidism and is potentially life-threatening. what is the clinical presentation of this condition?

A

exaggeration of usual physiological response seen in hyperthyroidism and can occur after trauma, childbirth, surgery, infection or stroke in people with untreated or poorly controlled hyperthyroidism: tachycardia, fever, AF, HF, fever, diarrhoea, jaundice, agitation, delirium and coma

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9
Q

when should you refer someone with hyperthyroidisms to endocrinologist?

A

admit as a medical emergency a person with symptoms of thyroid storm

refer using a suspected cancer pathway (app. within 2 weeks) is person has thyroid nodule or goitre and malignancy is suspected

refer all others with overt hyperthyroidism, urgency depending on clinical judgement, for further Ix and management

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10
Q

describe how you would interpret TFT results to diagnose hyperthyroidism

A

includes TSH, free thyroxine (fT4) and free triiodothyronine (fT3)

  • TSH is usually the most useful. will be low because of -ve feedback mechanisms
  • a low TSH and high fT4 is consistent with hyperthyroidism
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11
Q

list the differences between aetiologies of a benign and malignant thyroid nodule

A

benign: colloid nodule, adenoma focal thyroiditis, thyroid cyst, benign lymph node hypertrophy, parathyroid cyst
malignant: papillary, follicular, medullary and anaplastic thyroid carcinoma; lymphoma or metastasis to thyroid

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12
Q

what percentage of thyroid nodules contain cancerous cells?

A

5%

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13
Q

what medication can be offered at low dose (can be increased if necessary) to help improve symptoms of hyperthyroidism while patient waits for endocrinologist appointment? what are the 4 major contraindications?

A

propranolol (B-blocker) to provide relief from adrenergic symptoms, particularly anxiety and tachycardia

CI’s:

  1. asthma
  2. uncontrolled HF
  3. marked bradycardia
  4. hypotension
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14
Q

what are the 5 questions pt’s should be asking to take more control of their healthcare -> realistic medicine!

A
  1. need
  2. benefit
  3. risks
  4. choice
  5. if I don’t?
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15
Q

beta blockers can only help symptoms of hyperthyroidism, not the underlying cause. what are the 3 options for long term management of the underlying cause of hyperthyroidism?

A
  1. anti-thyroid drugs
  2. radioiodine
  3. surgery
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16
Q

ant-thyroid drugs are first line in hyperthyroidism. what is the most common drug used, its MoA and SEs

A
  • Carbimazole (propylthiouracil also used)
  • inhibits the formation of thyroid hormones
  • SE’s = rash and nausea. must highlight the potential risk of agranulocytosis -> drug affects the bone marrow, decreasing the no. of WBCs that can fight infection. ALL pt’s should be warned to stop medication and seek urgent medical advice if they develop a sore throat or fever
  • if pt starts this drug will need regular review and blood tests

(can offer pt leaflet from British Thyroid Foundation explaining how drugs are used to treat hyperthyroidism)

17
Q

during thyroidectomy what nerve is more at risk of damage?

A

recurrent laryngeal nerve (especially on the right)

- hoarse voice

18
Q

describe the clinical symptoms of the following diseases that affect the pituitary gland:

a) Cushing’s
b) hypopituitarism
c) acromegaly

A

a) obesity (trunk, head and neck ‘buffalo hump’); proximal muscle wasting; moon-shaped, plethoric face; easy bruising; abdominal striae; hypertension, ankle oedema; increase susceptibility to infection; diabetes; osteoporosis; psychotic behaviour; increased androgen secretion with acne, oligomenorrhoea in females
b) depends on the degree of deficiency of 1 or more pituitary hormones. symptoms may be headaches, amenorrhoea, galactorrhoea, visual field defects, failure to thrive, infertility, hypoglycaemia
c) coarsening of facial features (enlarged nose and jaw, separation of teeth), increased skin thickness and soft tissue hypertrophy, skin tags and increased sweating. bilateral carpal tunnel syndrome, joint pain, sleep apnoea

19
Q

what is the difference between Cushing disease vs syndrome

A

the disease is caused by a pituitary gland tumour (usually benign) that over-secretes the hormone ACTH, thus overstimulating the adrenal glands’ cortisol production. Cushing syndrome refers to the signs and symptoms associated with excess cortisol in the body, regardless of the cause

20
Q

how would you treat hypothyroidism?

A

L-thyroxine

Week 30: Tired All The Time 2 (1 decks)

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