Medicine- Hypothyroidism + Pancreatic Ca Flashcards
(34 cards)
Which of these is a cause of hypothyroidism?
a) Hashimoto’s disease
b) Grave’s disease
c) Levothyroxine excess
d) Iodine excess
a) Hashimoto’s disease
Hashimoto’s is a type of autoimmune hypothyroidism
Which of these signs would you expect to see in hypothyroidism?
a) Palmar erythema
b) Tachycardia
c) Ascites
d) Brisk reflexes
c) Ascites
What would you expect to see in secondary/central hypothyroidism?
a) TSH raised, T4 raised
b) TSH raised, T4 reduced
c) TSH normal, T4 raised
d) TSH reduced, T4 reduced
d) TSH reduced, T4 reduced
What is ‘Hypothyroidism?
• Hypothyroid disease/hypothyroidism: a clinical state resulting from underproduction of the thyroid hormones T3 and T4
Primary hypothyroidism can be caused by?
- Autoimmune thyroiditis (Hashimoto’s disease)
- Iodine deficiency - (major cause worldwide)
- Primary atrophic hypothyroidism (autoimmune)
- Post-thyroidectomy/radioiodine treatment
- Drug-induced : Amiodarone, lithium, over-treatment of hyperthyroidism
- Subacute thyroiditis
- Malignancy
Secondary hypothyroidism can be caused by?
- lack of TSH production usually due to hypopituitarism (pituitary adenoma or necrosis)
- Infiltrative disease such as tuberculosis or hemochromatosis
Symptoms of hypothyroidism?
- Weakness
- Lethargy
- Cold sensitivity
- Weight gain
- Goitre development
- Depression/psychosis
- Menstrual irregularity, pain
- Myalgia, cramps
- Constipation
- Decreased libido
- Dry skin or hair
History of hypothyroidism patient
- For hypothyroidism the patient will usually present with fatigue, low mood and maybe a few more specific symptoms
- In the history it is important to then ask about specific symptoms of hypothyroidism to try to determine if this is the most probable diagnosis.
- Such as asking about specific symptoms/signs in hypothyroidism
Epidemiology of hypothyroidism
- Family history of autoimmune thyroiditis
- Female sex
- Middle age
- Other autoimmune conditions (type 1 DM, Addison’s, pernicious anaemia)
- Iodine deficiency
- Grave’s disease
- Amiodarone/lithium use
- Radiotherapy
- Turner’s and Down’s syndrome
Ix for hypothyroidism
Differentials for hypothyroidism?
- Primary hypothyroidism
- Secondary hypothyroidism
- Depression
- Alzheimer’s dementia
- Anaemia
- Malignancy
Conservative and medical management for hypothyroidism
Clinical examination
what is the pneumonic for hypothyroidism
A 50 year old female presents with increasing fatigue and low mood. On examination she is bradycardic, has cold hands and a goitre.
Which other signs might you expect to see in this lady?
a) Increased reflexes
b) Ascites
c) Unsteady stature
d) Tremor
b) Ascites
c) Unsteady stature
A 50 year old female presents with increasing fatigue and low mood. On examination she is bradycardic, has cold hands and a goitre
A TSH and T4 blood tests are sent and confirm primary hypothyroidism, what results would you expect to see?
a) TSH raised, T4 raised
b) TSH decreased, T4 raised
c) TSH decreased, T4 decreased
d) TSH raised, T4 decreased
d) TSH raised, T4 decreased
A 50 year old female presents with increasing fatigue and low mood. On examination she is bradycardic, has cold hands and a goitre
What would be your initial management and treatment?
a) Give levothyroxine
b) FNA and ultrasound to exclude malignancy
c) Lifestyle advice d
) Thyroid antibodies screen and FBC/LFTS/U+Es
ALL
What is the function of the pancreas?
a) Secrete bile
b) Secrete pepsinogen
c) Secrete insulin and glucagon
d) Secrete trypsinogen
c) Secrete insulin and glucagon
d) Secrete trypsinogen
Chief cells produce
chief cells produce pepsinogen
What cells secrete enzymes in the pancreas?
a) Ductal cells
b) Chief cells
c) Acinar cells
d) Parietal cells
c) Acinar cells
What hormone stimulates the release of enzymes in the pancreas?
a) Secretin
b) Cholecystokinin
c) GIP
a) Somatostatin
b) Cholecystokinin
What is Pancreatic Cancer?
- Cancer of the pancreas
- Ductal adenocarcinoma (most common)
- 60% arise in the head, 25% body, 15% tail
Majority of individuals with pancreatic ca will have mutations in the _____ __
Majority of individuals with pancreatic ca will have mutations in the KRAS2 gene
Symptoms for pancreatic cancer?
History of pancreatic ca patient?
- Unexplained non-specific upper abdominal pain
- Persistent back pain (retroperitoneal metastases
) • (tail and body tumours may present with epigastric pain) Relieved on sitting forward
- Signs of pancreatic insufficiency (e.g. steatorrhoea)
- Smoking
- Family history
- Other hereditary cancer syndromes (e.g. Peutz-Jeghers syndrome, BRCA1/2 mutations)
