Summary Flashcards
Describe hyperthyroidism
Overproduction of thyroid hormones T3 and T4
Thyrotoxicosis effects of abnormal or excessive amounts of thyroid hormone
What are the symptoms of hyperthyroidism?
Weight loss, heat intolerance, fatigue, insomnia, sexual disfunction, goitre, and brisk reflexes
What is the treatment for hyperthyroidism?
Carbimazole (teratogenic esp. in first trimester)and Propylthiouracil - first line anti-thyroid drug
May need levothyroxine if it blocks all function
RAI
Describe Graves disease
Autoimmune drive condition where thyroid peroxidase and TSH receptor antibodies are seen
The anti-TSH receptor antibodies stimulate activity
What are the features of Graves disease?
Weight loss, heat intolerance, sexual dysfunction, tachycardia, goitre, and brisk reflexes.
Graves eye disease - exophthalmos and pretibial myxoedema
Also, thyroid acropachy - clubbing and hand swelling
What is the treatment for Graves disease?
Anti-thyroid drug - carbimazole
BB to relive symptoms
Describe toxic multinodular goitre
Condition where nodule develop on thyroid gland which are upregulated by thyroid axis and produce excess TH
Common cause of thyrotoxicosis in elderly
What are the features of toxic multinodular goitre?
Characteristic goitre and absence of Graves disease
General hyperthyroidism symptoms - weight loss, heat intolerance, tachycardia, brisk reflexes and fatigue
Describe Subacute (de Quervain’s) thyroiditis
Condition where there is temporary swelling of thyroid gland with 3 phases - thyrotoxicosis, hypothyroidism, and returns to normal
What is the cause of De Quervain’s thyroiditis?
Viral trigger - enteroviruses and coxsackie
What are the symptoms and signs of De Quervains thyroiditis?
During thyrotoxicosis - thyroid swelling and tenderness, flu like illness and myalgia
Raised ESR and CRP
What is the treatment for De Quervain’s thyroiditis?
May need short term steroids and NSAIDs
Describe subclinical hyperthyroidism
Thyroid hormone level is normal but TSH levels are low
Concern for bone density decrease
When are ATD used for subclinical hyperthyroidism?
If persistent esp. in elderly and if have cardiac risk
Describe primary hypothyroidism
Insufficient production of T3 and T4 thyroid hormones
Increased TSH from negative feedback but has no effect on TH
What are the symptoms of primary hypothyroidism?
Weight gain, fatigue, dry skin, course hair, heavy irregular periods, and constipation.
Cold intolerance, non-specific weakness, and bradycardia
What is the treatment for primary hypothyroidism?
Oral levothyroxine - synthetic version of T4
Dose titrated by TSH levels
Describe secondary hypothyroidism
Pituitary abnormally produces inadequate TSH which results in inadequate stimulation of the thyroid gland
T3, T4 and TSH will be low
What is the treatment for secondary hypothyroidism?
Oral levothyroxine
Describe Hashimoto’s thyroiditis
Autoimmune condition resulting in an underactive thyroid gland
Autoimmune destruction of thyroid epithelial
Autoantibodies for thyroglobulin and thyroid peroxidase
What are the symptoms of Hashimoto’s thyroiditis?
Diffuse enlargement of goitre and general hypothyroidism symptoms - weight gain, cold tolerance, bradycardia, dry skin, course hair and weakness in muscles
Describe Addison’s disease
Primary adrenal insufficiency
Most common cause is autoimmune damage
Causes decreased cortisol and aldosterone secretion
What are the symptoms of Addison’s disease?
Weakness, anorexia, weight loss, skin pigmentation or vitiligo, hypotension, salt craving, postural symptoms and unexplained vomiting
What is the investigations for Addison’s disease?
Synacthen test - if abnormal then plasma ACTH which is elevated - Addison’s
Check for adrenal autoantibodies
What is the treatment for Addison’s disease?
Hydrocortisone (glucocorticoid) is used to replace cortisol
Fludrocortisone (mineralocorticoid) to replace aldosterone
Describe secondary adrenal insufficiency
Inadequate ACTH which results in lack of stimulation of adrenal glands
What are the symptoms of secondary adrenal insufficiency?
Fatigue, muscle, weakness, muscle cramps, dizziness, thirst, craving salt, abdo pain, depression, hypotension and bronze hyperpigmentation
Describe Cushing’s syndrome
Prolonged high levels of corticosteroids in the body - glucocorticoids (cortisol) and mineralocorticoids (aldosterone)
Can be ACTH dependant or independent
What are the symptoms of Cushing’s syndrome?
Weakness of skin, muscles + bones, hypertension, HF, and may cause DM.
Signs - central obesity, hirsutism, purple striae, proximal weakness, moon face, buffalo lump, and oedema
What is the investigations for Cushing’s syndrome?
24hr urinary free cortisol
1mg overnight dexamethasone suppression test taken at midnight - lack of cortisol response shows Cushing’s
What is the treatment for Cushing’s syndrome?
Trans-sphenoidal surgery if pituitary adenoma
Medical - adrenal hormone synthesis inhibitors (ketoconazole, metyrapone, amino glutethimide and etomidate)
Also, Milotane to destroy adrenocortical cells
RT and bilateral adrenalectomy
What is Cushing’s disease?
Pituitary adenoma secreting excessive ACTH which stimulates excessive cortisol release from adrenal glands
What is Conn’s syndrome?
Adrenal adenoma producing too much aldosterone which controls blood pressure and sodium/ potassium levels
Primary hyper-aldosteronism
What are the symptoms of Conn’s syndrome?
Uncontrolled increasing BP, excessive thirst, increased urinary frequency, nocturia, weakness/ tingling, dizziness, blurred vision, and headaches.
What is the treatment for Conn’s syndrome?
Fludrocortisone (mineralocorticoid) is used to replace aldosterone
What is the investigation for Conn’s syndrome?
Bloods for aldosterone, renin, sodium, and potassium levels.
CT scan
Suppression tests, such as saline or a captopril suppression test.
Describe primary hyperaldosteronism
Adrenal glands are responsible for overproduction of aldosterone
Hypertension is a key feature
What is the investigations for primary and secondary hyperaldosteronism?
Primary - high aldosterone and low renin
Secondary - high aldosterone and high renin
Raised BP, hypokalaemia and alkalosis
What is secondary hyperaldosteronism?
Excessive renin stimulating the release of excessive aldosterone
Released due to disproportionally lower BP
Describe a pheochromocytoma
Tumour of the adrenal glands that excretes excessive and unregulated amounts of catecholamines (adrenaline)
In medulla of adrenal gland
10% tumour
What is the symptoms of pheochronocytoma?
Hypertension, paroxysmal attacks - headaches, sweating, palpitations, tachycardia, tremor, pallor and anxiety/ fear
What is the investigations for pheochromocytoma?
24hr urine measure total metaphrines - if increased then MRI or CT scan
If mass seen then consider 123-IMIBG scan
What is the treatment for pheochromocytoma?
Pre-operative alpha blockage then surgical resection
Describe type I diabetes
Pancreases is unable to produce adequate amounts of insulin which means cell can not absorb glucose
Hypercalcaemia and early age of onset
What is the symptoms of type I diabetes?
Short duration of thirst, tiredness, weight loss, blurred vision and abnormal pain from high ketones
Ketones on breath, increased RR, tachycardia, hypotension and low grade infections
Describe type II diabetes
Condition where there is insulin resistance and reduced insulin production leading to hyperglycaemia
Usually older age and overweight
What are the symptoms of type II diabetes?
Thirst, tiredness, polyuria, weight loss, blurred vision, and signs of complications (CVD)
No ketones, usually overweight and low grade infections
Acanthosis nigricans (thickening and darkening of skin)
What is acromegaly?
Result of excessive growth hormone due to pituitary tumour
After epiphyseal plates have closed so growth happens in outward direction
What is the symptoms of acromegaly?
Normal height, enlarged hands, feet with prominent facial features and bitemporal hemianopia
Headaches, course, sweaty skin, large tongue, and spacing of teeth
Also, hypertension
What is the treatment for acromegaly?
Surgery to remove tumour or somatostatin analogues to treat
What are the investigations for acromegaly?
IGF-1 measured in blood test - raised
GH suppression test - 75g sugary drink with GH tested after 2 hrs
If not suppressed then shows acromegaly
MRI
Describe gigantism
Excessive growth hormone production before the epiphyseal plates of long bones close
Describe hyperparathyroidism
Raised parathyroid hormone
PTH acts to raise Ca levels and converts vitamin D to active form
Primary - uncontrolled PTH release
Secondary - decrease in Ca resorption so low Ca - increases PTH
What are the symptoms of hyperparathyroidism?
Stones, bones, groans, and moans.
Kidney stones, painful bones, abdominal groans from constipation + N/V, and psychiatric moans - fatigue, depression and psychosis
What is adrenal crisis?
Acute presentation of adrenal insufficiency where absence of steroid hormones leads to medical emergency
What is the symptoms for adrenal crisis?
Can present with reduced consciousness levels, hypotension, hypoglycaemia, hyperkalaemia, and hyponatraemia
What is the treatment for adrenal crisis?
IM or IV hydrocortisone and IV fluids
Correct hypoglycaemia and careful monitoring of electrolytes
