Thyroid Flashcards
initial treatment for Graves for symptomatic relief
beta blocker: propranolol
if Graves patients not controlled with beta blocker, give…
carbimazole
adverse affects of radio iodine therapy
hypothyroidism
precipitation of thyroid eye disease
major complication of carbimazole
agranulocytosis
Graves investigations
TSH
T4
TSH: low
T4: high
what medication can reduce absorption of levothyroxine and induce hypothyroidism?
ferrous sulphate (iron / calcium carbonate tablets)
target TSH while on thyroxine treatment
0.5-2.5
over-replacement of levothyroxine leading to overshot TSH can lead to
osteoporosis
when and how should levothyroxine be taken
30 mins before breakfast, caffeine and other medications
how far apart should iron and levothyxoine be taken
4 hours
pregnant women with hypothyroidism levothyroxine dose changes
should be increased by 25-50micrograms
if TSH up but >10, and T4 normal and patient
-asymptomatic
-symptomatic <65
-symptomatic >65
-observe and repeat in 6 months
-trial levothyroxine
-watch and wait, avoid hormones
if TSH is high its always
primary hypothyroidism
Graves disease pathophys
TSHR autoantibodies binds to TSH receptor -> T3 and T4 stimulated -> negative feedback loop decreases production of TSH -> T3 and T4 continue to rise
hypothyroidism treatment in elderly
25mg titrated up
long term amiodarone side effects
hypothyroidism and thyrotoxicosis
common features of primary hyperparathyroidism
thirsty elderly female with sore bones
‘bones, stones, abdo groans and psychic moans.
most common cause and pathophys of primary hyperparathyroidism
solitary adenoma - > increased PTH -> hypercalcaemia
primary hyperparathyroidism investigations
PTH raised or normal
Ca raised
Phosphate raised
secondary hyperparathyroidism cause
chronic kidney disease or vit D-> hypocalceamia -> raised PTH
secondary hyperparathyroidism investigations
PTH raised
Ca low
tertiary hyperparathyroidism cause
caused by chronic secondary HPTism hyperplasia
tertiary hyperparathyroidism investigations
PTH increased significantly
Ca low
subacute thyroiditis symptoms
painful tender goitre
raised ESR
hyperthyroidism
globally reduced iodine uptake
myxoedema coma treatment
IV thyroid hormone and IV hydrocortisone
primary hyperparathyroid cause
parathyroid adenoma
hyperthyroid medication in pregnancy
first trimester use propylthiouracil, switched to carbimazole in 2/3rd trimester (severe hepatic injury)
definitive management of primary hyperparathyroidism
total parathyroidectomy
