Lecture 21 Clinical Thyroid Disease Flashcards
Symptoms of hypothyroid
- Weight Gain
- Lethargy
- Feeling cold
- Constipation
- Heavy periods
- Dry Skin/Hair
- Bradycardia
- Slow reflexes
- Goitre
- Severe – puffy face, large tongue, hoarseness, coma
Symptoms of hyperthyroid
- Weight Loss
- Anxiety/Irritability
- Heat Intolerance
- Bowel frequency
- Light periods
- Sweaty palms
- Palpitations
- Hyperreflexia/Tremors
- Goitre
- Thyroid eye symptoms/signs
Primary Hypothyroidism thyroid and TSH levels
Low T3/T4
Raised TSH/TRH
Subclinical hypothyroidism thyroid hormone and tSH levels
Normal T3/T4
Raised TSH
Secondary hypothyroidism thyroid hormone and TSH level
Low TSH
Low T3/T4
Causes of primary Hypothyroidism
Agenesis Dyshormonogenesis Hashimoto's Postoperative Cancers AT drugs Post partum
Causes of secondary hypothyroidism
Pituitary tumour
Craniopharyngioma (rare type of noncancerous (benign) brain tumour)
Post pituitary surgery or radiotherapy
Investigations for hypothyroidism
TSH T4 Autoantibodies- thyroglobulin =TPO FBC- increased MCV Lipids- raised Hyponatremia Increased muscle enzymes- ALT, CK Hyperprolactinaemia
Treatment for Hypothyroidism
- Levothyroxine (T4) tablets
- (Liothyronine (T3))
- After stabilisation annual testing of TSH
What is the management of subclinical hypothyroidism
• Repeat tests after 2-3 months with TPO antibodies
• Consider treatment TSH > 10
• TSH > 5 with symptoms
– Trial of therapy for 6 months and continue if symptomatic improvement
– If not stop and annual monitoring if TPO+ or every 2 to 3 years
• Risks of over treatment -osteopenia and atrial fibrillation
How is Hypothyroidism managed in pregnancy
Increased Levothyroxine
by about 25% and monitor closely
Inadequate treatment is linked with increased foetal loss and lower IQ
What are the causes of Goitre
Puberty Pregnancy Grave's disease Hashimoto's disease Thyroididitis Iodine deficiency Dyshomonogenesis Goitrogens
Name the Goitre types
Multinodular Diffuse (colloid or simple) Cysts Adenoma Carcinoma Lymphoma Sarcoidosis, TB
What is the thyroid cancer management
Prognosis is poor
• Near Total Thyroidectomy
• High dose radioiodine (Ablative)
• Long term suppressive doses of thyroxine
• Followup
– Thyroglobulin
– Whole body iodine scanning (following 2-4 weeks of thyroxine withdrawal or recombinant TSH injections)
What are the types of thyroid cancer
Differentiated
Papillary
Follicular
What is Medullary Thyroid cancer
Tumour from the parafollicular C cells
Serum calcitonin is raised
Primary causes of thyrotoxicosis
Grave’s
Toxic multinodular Goitre
Toxic adenoma
Secondary causes of Thyrotoxicosis
Pituitary adenoma secreting TSH
What is the most common cause of thyrotoxicosis in the elderly
Mutli-nodular goitre
What thyroiditis has a viral trigger
Subacute (de Quervain’s) thyroiditis
What is the management and treatment of hyperthyroidism
- Beta blockers
- Surgery
- Radioactive Iodine
- Anti-thyroid drug- Crabimazole, Propylthiouracil
What are the 2 methods of administering anti-thyroid drugs
Titration
Block and replace
What is involved in the titration regimen for treating hyperthyroidism
starting dose is 15–30 mg/day methimazole (or equivalent doses of other thionamides); further to periodic thyroid status assessment, daily dose is tapered down to the lowest effective dose
What is involved in the block and replace regimen for treating hyperthyroidism
– You continue taking CMZ, usually 20-40mg daily, or PTU, usually 200-400mg daily, to stop your thyroid gland producing thyroid hormone; and start taking levothyroxine (usually 50-150mcg daily) to replace the thyroid hormone your body would normally produce
When would treatment of ATD/RAI be considered in subclinical hyperthyroidism
In elderly or those with increased cardiac risk
