The list - endocrine Flashcards
Hyperthyroidism:
State 3 mechanisms for increased levels of thyroid hormone
- Overproduction of thyroid hormone
- Leakage of preformed hormone from thyroid
- Ingestion of excess thyroid hormone
Hyperthyroidism:
State some causes of hyperthyroidism
Graves' disease Toxic multinodular goitre Toxic adenoma Congenital hyperthyroidism Thyroiditis
Hyperthyroidism:
State 7 symptoms of hyperthyroidism
- Weight loss
- Tachycardia
- Anxiety
- Heat intolerance
- Sweating
- Diarrhoea
- Menstrual disturbance
Hyperthyroidism:
Name some Graves’ specific signs
Diffuse goitre
Thyroid eye disease
Acropachy (thickening of extremities - clubbing/swelling)
Hyperthyroidism:
Name 3 investigations you would do for suspected hyperthyroidism
- Thyroid function test (blood test for T3, T4 and TSH)
- Clinical history, physical signs
- Supporting investigations such as thyroid antibodies
Hyperthyroidism:
What is the treatment for hyperthyroidism (name 4)?
First line - antithyroid drugs
Beta blockers for symptoms
Radioiodine
Surgery (partial/subtotal thyroidectomy)
Hyperthyroidism:
Name 3 antithyroid drugs (thionamides) used in the treatment of hyperthyroidism
And how they work
Carbimazole, Propylthiouracil (PTU) and methimazole.
Decrease new thyroid hormone synthesis, PTU also inhibits conversion of T4 to T3 (do not treat underlying cause).
Hyperthyroidism:
Name the common side-effect, and some less common side-effects of thionamides
Common - rash
Less common - arthralgia, hepaitis, neuritis
Most severe is agranulocytosis
Graves’ disease:
Describe the pathology of Graves’ disease
An autoimmune disease where the immune system targets TSH receptors on the thyroid gland (via antibodies - TSH receptor stimulating antibody) This cause the gland to be overactive => Hyperthyroidism.
Graves’ disease:
In a thyroid function test, what would TSH, T4 and T3 be?
T3+T4 high
TSH low
TRAb (TSH-receptor stimulating antibody) has the same effect as TSH.
Graves’ disease:
Signs and symptoms
- Anxiety
- Fine tremor of hnds
- Heat sensitivity, increased perspiration or warm, moist skin
- Weight loss, despite normal eating
- Goiter
- Bulging eyes - Graves’ ophthalmology
- Thick, red skin on shins/dorsum of foot - Graves’ dermopathy
Graves’ disease:
What 4 investigations might we do?
Physical examination of eye - protrusion
Pulse and blood pressure - signs of tremor
Blood sample - looking at TSH and T3/4
Ultrasound to identify enlarged thyroid gland
Graves’ disease:
What is treatment (include what first line)
First line (NICE) - radioactive iodine therapy
Can give:
- Anti-thyroid medications
- Beta blockers - provide rapid relief for irregular heartbeats, tremors, heat intolerance and muscle weakness
- Orbital decompression surgery/corticosteroids for eyes
- Thyroidectomy
Graves disease:
Describe radioiodine
We give 131I (as oppose to 127I). This emits beta energy with minimal tissue penertration
Hashiomotos thyroiditis/autoimmune hypothyroidism:
Describe pathology
This is an autoimmune condition where autoantibodies destroy the thyroid gland causing hypothyroidism
Symptoms are same as hypothyroidism
Hashimotos thyroiditis:
Describe management
First line - synthetic thyroid hormone replacement
Also resection of obstructive goitre.
(same treatment as any hypothyroidism)
Hypothyroidism:
Describe the difference between primary, secondary and tertiary
Primary >99% - problem with the thyroid gland
Secondary - pituitary/hypothalamic dysfunction
Tertiary - withdrawal of thyroid suppressive therapy such as radioiodine
Hypothyroidism:
Name some causes of hypothyroidism
(3 primary, 1 secondary)
Primary: Hashimotos thyroiditis/autoimmune hypothyroidism, thyroidectomy, iodine deficiency
Secondary: Pituitary/hypothalamic disease
Hashiomotos thyroiditis/autoimmune hypothyroidism:
Describe pathology
Antibodies bind and block TSH receptors and destroy thyroid cells leading to inadequate thyroid hormone secretion
Hypothyroidism:
Describe the symptoms
Fatigue, loss of energy, lethargy Weight gain Decreased appetite Cold intolerance Dry skin Muscle pain, joint pain, weak extremities Depression/emotional lability Impaired memory/ability to concentrate Constipation Menstrual disturbances Decreased perspiration Paraesthesia/nerve entrapment Blurred vision
Is thyroiditis hyper or hypo?
Usualy inflammation from Hashimotos or chronic lymphocytic thyroiditis leads to hypothyroidism
Hashiomotos thyroiditis/autoimmune hypothyroidism:
Name investigations which confirm diagnosis
Diagnosis is based on signs and symptoms
Blood tests include hormone test (high TSH, low T3/T4) or antibody test (TPO antibodies, or antibodies against thyroid peroxidase)
Thyroid cancer:
describe pathology
Epithelial tumours that originate from thyroid follicular cells.
From what I have read it neither causes hypo or hyper
