Pass Med Flashcards
De Quervain’s Thyroiditis
Sub acute thyroiditis causing hyper then hypothyroidism
Cushing’s Syndrome - Acid base
Low K+, metabolic alkalosis
4 phases of Subacute thyroiditis (de quervain)
phase 1 (lasts 3-6 weeks): hyperthyroidism, painful goitre, raised ESR phase 2 (1-3 weeks): euthyroid phase 3 (weeks - months): hypothyroidism phase 4: thyroid structure and function goes back to normal
Sub Acute thyroiditis
3 characteristics
On USS scan
Following viral infection
= Tender goitre, hyperthyroidism and raised ESR
Decreased iodine uptake
Antibodies in Graves’ Disease
TSH receptor stimulating autoantibodies
Addisonian Crisis - Bloods
High K+
Low Sodium
Hypovolaemia
Hashimoto’s thyroiditis
- Antibodies
Anti thyroid perxoidase antibodies causing hypothyroidism
HbA1c Target - T2DM
Lifestyle
- 48
Monotherapy
- 48
- If rises to >58 then add another agent
Dual/Triple/Insulin
- 53
T2DM BP targets
No end organ damage
< 140/80
End organ damage
< 130/80
Acromegaly - Diagnostic test
Oral glucose tolerance test then GH measurements
In acromegaly, GH is not supressed by the Glucose (should be <2mu/L when pt is hyperglycaemic)
TFTs: Hyperthyroidism
Graves/toxic multinodular goitre
Low TSH
high Free T4
TFTs: Primary hypothyroidism
High TSH
Low T4
TFTs: Secondary hypothyroidism
Low TSH
Low T4
TFTs: Sick Euthyroid
Low TSH
Low T4
Common in hospital patients - caused by non-thyroid illness
TFTS: Subclinical Hypothryoidism
High TSH
Normal T4
TFTs: Poor compliance with thyroxine
High TSH
Normal T4
TFTs: Steroid Therapy
Low TSH
Normal T4
Hormones reduced in stress response (3)
Insulin
Testosterone
Oestrogen
Hormones increased in stress response
Growth Hormone Cortisol Renin ACTH Aldosterone Prolactin ADH Glucagon
Thyroid Eye disease - Risk Factor
Smoking!
Mx Steroid Doses in unwell patient on chronic replacement
Hydrocortisone = double the dose
Fludrocortisone = keep the same
MEN Type 1 - 3 Ps
Parathyroid (high), pituitary, pancreas
Usually presents with hypercalcaemia
MEN Type 2a - 2Ps
Parathyroid, Phaeochromocytoma
Medullary thyroid cancer
MEN type 2b - 1 P
Phaeochromcytoma
