Revision Day Flashcards
How is diagnosis of Grave’s confirmed?
thyroid autoantibodies
Onset of Grave’s disease vs autonomous nodules?
Grave’s - frequently acute
Autonomous nodules (e.g. TMN goitre) - more insidious onset
What autoantibodies are seen in Grave’s?
1) TRAB / TBII (thyroid receptor stimulating antibodies) - most helpful
2) TPO (thyroid-peroxidase) - less helpful
Is routine USS required in Grave’s?
No
If antibody test is negative in susoected Grave’s, what is next investigation?
Thyroid uptake scan
What 2 eye signs are seen in any cause of thyrotoxicosis?
Lid retraction & lid lag
Eye signs associated with Grave’s?
- periorbital swelling
- conjunctival injection
- proptosis/expohthalmos
- lid asymmetry
- muscle tethering causing diplopia, ophthalmoplegia
What is a thyroid bruit?
Systolic bruit heard over the goitre due to increased vascularity
Seen only in Grave’s
What is a thyroid storm?
Rare, life-threatening condition, severe manifestation of thyrotoxicosis.
Clinical signs of thyroid storm?
- alteration in mental status
- high fever
- tachycardia/tachyarrhythmias
- vomiting, jaundice, diarrhoea
- multisystem decompensation e.g. cardiac failure, respiratory distress
Triggers for a thyroid storm?
- acute event e.g. thyroid or nonthyroidal surgery, trauma, infection
- acute iodine load (inc. amiodarone use)
Mx of thyroid storm?
General supportive therapy:
- intensive care monitoring
- beta blockers (if CI then CCBs)
- high dose propylthiouracil (via NG)
- high dose glucocorticoids
Propylthiouracil vs carbimazole in a thyroid storm?
Propylthiouracil preferred
What is myxoedema coma?
Rare, severe complication of hypothyroidism
What are those in myxoedema coma at risk of?
Cardiac failure & respiratory failure –> endocrine emergency!
Features of myxoedema coma?
- hypothermia
- bradycardia
- hypoglycaemia
- altered mental status - low GCS, convulsion
- unconsciousness, risk of death
What typically precedes myxoedema coma?
- cold exposure
- trauma
- infection
- CNS depressants
Mx of myxoedema coma?
IV levothyroxine
IV hydrocortisone (until adrenal insufficiency ruled out)
Requires ICU monitoring
Immediate mx of 1ary hyperparathyroidism?
IV fluids
At least 3L/24h and repeat Ca daily
Role of calcinet?
Cinacalcet reduces parathyroid hormone which leads to a decrease in serum calcium concentrations. Indications and dose.
Correction rate of hyponatraemia in adrenal insufficiency?
Aim to correct by no more than 10 mmol/L in first 24h
