PassMedicine Flashcards
what is menorrhagia found in
hypothyroidism
what is oligomenorrhea found in
thyrotoxicosis
what is the most common cause of hypothyroidism
hashimotos thyroiditis
- most common cause
- autoimmune
- associated with T1DM
- more common in women
what is the most common cause of thyrotoxicosis
graves disease
what are the TSH and free T4 levels in thyrotoxicosis (graves)
low TSH
high free T4
what are the TSH and free T4 levels in hypothyroidism (hashimotos)
high TSH
low free T4
treatment for hypothyroidism
thyroxine in the form levothyroxine
treatment for thyrotoxicosis
1 propranolol to control symptoms (tremor)
2 carbimazole
3 radioiodine treatment
MOA for carbimazole
blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin → reducing thyroid hormone production
what is thyroid acropachy and is it found in hypo or hyperthyroidism
clubbing
hyper
is non-pitting oedema in hands and face found in hypo or hyperthyroidism
hypothyroidism
anti-TPO antibodies are seen in 90% of which patients
hashimotos thyroiditis
MODY definition`
group of inherited genetic disorders affecting insulin production
is carpal tunnel syndrome commonly seen in hypothyroidism or hyperthyroidism
hypothyroidism
are thyroid disorders more common in men or women
women
what does TRH (thyrotropin releasing hormone) stimulate
anterior pituitary
how can thyroid disorders be classified
primary - problem with thyroid gland
secondary - problem with pituitary
what is the most common cause of hypothyroidism
hashimotos thyroiditis
-autoimmune
what is the most common cause of thyrotoxicosis
graves disease
what are the less common causes of hypothyroidism
1 subacute thyroiditis (de quervains) -painful goitre + raised ESR 2 riedel thyroiditis -painless goitre -fibrous tissue replaces thyroid tissue 3 postpartum thyroiditis
what are the less common causes of thyrotoxicosis
1 toxic multinodular goitre
-autonomously functioning thyroid nodules which secrete excess thyroid hormones
what drug can cause both hypothyroidism and thyrotoxicosis
amiodarone
what is the most common cause of hypothyroidism in the developing world
iodine deficiency
what two drugs can cause hypothyroidism
lithium
amiodarone
TSH-receptor antibodies are found in what condition
thyrotoxicosis by graves disease
anti-TPO antibodies are found in what condition
hashimoto’s thyroiditis
main treatment for hypothyroidism
levothyroxine
main treatment for thyrotoxicosis
carbimazole
what is the MOA of carbimazole
blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin → reducing thyroid hormone production
what is the risk of carbimazole
agranulocytosis
SEs of sulfonylureas
hypoglycaemia
weight gain
hyponatraemia
def of T1DM
autoimmune disorder whereby insulin-producing beta cells of the islets of langerhans in the pancreas are destroyed by the immune system
this causes an absolute deficiency of insulin leading to hyperglycaemia
who is T1DM common in
children and young adults
def of T2DM
caused by relative deficiency of insulin due to excess adipose tissue
who does T2DM affect
older adults who are fatter
what is MODY
a group of inherited genetic disorders affecting the production of insulin
who does MODY commonly affect
younger patients with similar symptoms to T2DM
what are is the characteristic triad of T1DM
weight loss
polydipsia
polyuria
what are characteristic symptoms of T2DM
polydipsia
polyuria
why do polydipsia and polyuria occur in diabetes
high glucose levels cause glucose to be excreted in the urine
glucose has an osmotic effect and so pulls water into the urine causing polyuria
this in turn causes polydipsia
what is the diagnostic criteria for diabetes
fasting glucose >7
random glucose >11.1
An elderly patient presents with bone pain, depression, renal stones and recurrent peptic ulcer
primary hyperparathyroidism
where is cortisol produced
zona fasciculata of the adrenal cortex
what is the mneumonic for zones of the adrenals and the hormones they produce
Go Find Rex, Make Good Sex
Glomerulosa
Fasciculata
Reticularis
Mineralocorticoids
Glucocorticoids
Sex hormones
what is the mneumonic for adrenal hormones and what those hormones control
Salt Sugar Sex: The deeper you go the sweeter it gets
salt (mineralocorticoids)
sugar (glucocorticoids)
sex (weak androgens)
what are functions of cortisol
increases: 1 BP 2 Insulin resistance 3 gluconeogenesis, lipolysis inhibits: 1 bone formation 2 inflammatory + immune responses
what increases levels of cortisol
ACTH from pituitary gland (stimulated by corticotrophin-releasing hormone of hypothalamus)
stress
a 35-year-old woman is found to have a blood pressure of 180/110 mmHg. She complains of feeling tired and weak. Routine bloods show hypokalaemia
primary hyperaldosteronism
a 30-year-old woman presents with weight gain and irregular menstruation. Her blood pressure is elevated at 170/100 mmHg and there is evidence of proximal muscle weakness
Cushing’s syndrome
what are features of primary hyperaldosteronism
HARPS
HTN Alkalosis + Aldosterone high Renin low Potassium decreased (muscle weakness) Sodium high
what are the investigations for suspected primary hyperaldosteronism
ABCD
Adrenal scintigraphy
-differentiates between conns and bilateral adrenal hyperplasia by measuring adnrenal vein aldosterone levels
Bloods
-high aldosterone
-low renin
CT abdomen
Diurnal + postural measurements of aldosterone and renin
what is primary hyperaldosteronism aka
conns syndrome
management of adrenal adenoma
surgery
management of bilateral adrenocortical hyperplasia
aldosterone antagonist (spironolactone)
what (drug) has very high mineralocorticoid therapy but minimal glucocorticoid activity
fludrocortisone
what (drug) has high mineralocorticoid therapy with some glucocorticoid activity
hydrocortisone
what (drug) has high glucocorticoid therapy with low mineralocorticoid activity
prednisolone
what (drug) has very high glucocorticoid therapy with minimal mineralocorticoid activity
dexamethasone
betmathasone
what are SEs of mineralocorticoids
fluid retention
HTN
what are SEs of corticosteroids
CORTICOSTEROID
Cushings syndrome (moon face, buffalo hump, striae) Osteoporosis Retardation of growth Thin skin (Cushings) Immunosuppression + Infection Cataracts + glaucoma Oedema Suppression of HPA axis Thinning + ulceration of gastric mucosa (peptic ulceration) Emotional disturbance Rise in BP Increase in hair growth (hirsuitism) Others (hypokalaemia) DM precipitation
what are features of hashimotos thyroiditis
features of hypothyroidism (features of hyperthyroidism will be present initially for a transient period)
goitre which is non-tender
anti-thyroid peroxidase antibodies`
what can cause hypo and hyperthyroidism
amiodarone
A middle-aged women presents with symptoms of hypothyroidism. There is a diffuse, non-tender goitre on examination. TSH is raised, T4 is low, anti-TPO is positiv
hashimotos
what is subacute thyroiditis
de quervains thyroiditis
how does subacute thyroiditis present
after a viral infection
presents with features of hyperthyroidism
what are the phases of subacute thyroiditis
painful goitre, raised ESR, hyperthyroidism followed by a period of euthyroid followed by hypothyroidism
thyroid structure and function should return to normal after this
what would be seen on an iodine 131 scan for subacute thyroiditis
reduced uptake
A middle aged woman presents with a tender goitre and symptoms of hyperthyroidism. Bloods show a suppressed TSH and raised T4. There is a globally reduced uptake on iodine-131 scan
subacute thyroiditis
fibrous tissue replacing the normal thyroid parenchyma with a painless goitre
Riedel thyroiditis
nuclear scintigraphy reveals patchy uptake
autonomously functioning thyroid lesions that secrete excess thyroid hormones
Toxic multinodular goitre
what is thyroid lymphoma related to
hashimotos thyroiditis
A 45-year-old woman with a history of retroperitoneal fibrosis is found to have hypothyroidism. On examination a hard, fixed, painless goitre is noted
Riedel’s thyroiditis
what is characterised by Medullary thyroid cancer, hypercalcaemia, phaeochromocytoma
MENIIa
A patient is diagnosed as having medullary thyroid cancer. Her past medical history includes phaeochromocytoma and she is currently undergoing investigations for hypercalcaemia
MENIIa
A 30-year-old woman with a history of recurrent peptic ulcer disease is found to have hypercalcaemia on routine bloods
MENI
A man with a history of medullary thyroid cancer and phaeochromocytoma is noted to have a tall, thin, ‘marfanoid’ habitus. A number of small lumps are noted on his eyelids and lips
MENIIb
Medullary thyroid cancer, phaeochromocytoma, marfanoid body habitus
MEN IIb
Peptic ulceration, galactorrhoea, hypercalcaemia
MEN I
what would raised serum calcium, low serum phosphate, raised ALP and raised PTH
primary hyperparathyroidism
what would low serum calcium, raised serum phosphate, raised ALP and raised PTH
secondary hyperparathyroidism
what is characteristically caused by hyperparathyroidism
hypercalcaemia
An elderly patient presents with bone pain, depression, renal stones and recurrent peptic ulcer
primary hyperparathyroidism
low calcium and phosphate, high ALP and PTH
osteomalacia
high calcium, low phosphate, high ALP, high PTH
primary hyperparathyroidism
low calcium, high phosphate, high ALP, high PTH
secondary hyperparathyroidism
normal calcium, phosphate, PTH, high ALP
pagets disease
what drugs cause hypothyroidism
amiodarone
lithium
carbimazole
a 2-month-old baby is noted to have hypotonia, macroglossia and a puffy face. They were treated at birth for neonatal jaundice
congenital hypothyroidism
what syndrome is associated with hypothyroidism
downs syndrome
A middle-aged women presents with symptoms of hypothyroidism. There is a diffuse, non-tender goitre on examination. TSH is raised, T4 is low, anti-TPO is positive
hashimotos thyroiditis
a 45-year-old woman with a history of retroperitoneal fibrosis is found to have hypothyroidism. On examination a hard, fixed, painless goitre is noted
riedels thyroiditis
a middle aged woman presents with a tender goitre and symptoms of hyperthyroidism. Bloods show a suppressed TSH and raised T4. There is a globally reduced uptake on iodine-131 scan
subacute thyroiditis
hyponatraemia is associated with hyper or hypothyroidism
hypothyroidism
hypercalcaemia is associated with hyper or hypothyroidism
hyperthyroidism
A middle aged woman presents with thyrotoxicosis and a goitre. On examination there is exophthalmos and pretibial myxoedema. Anti-TSH receptor stimulating antibodies are positive
graves
