Thyroid Flashcards
What is in the Graves triad?
Exopthalmos, thyroid acropachy and pretibial myxoedema
Causes of hyperthyroidism?
Graves (most common) (TSHRAbs)
Toxic multinodular goitre
Toxic adenoma
De Quervains thyroiditis = increased release
What are toxic multinodular goitre features?
Autonomously functioning thyroid that secretes excess
In Elderly and iodine deficient areas
Features of De Quervains thyroiditis?
Post-viral infection, transient hyper->hypo->Euthyroid
Painful goitre, fever and raised ESR
Hyperthyroid investigations?
Thryoid exam and ECG
Bloods
Radioisotope scan for uptake
Thyroiditis management?
Usually self limiting, NSAIDS for thyroid pain and may require additional if very hyper/hypothyroid
Graves management?
Beta blockera
Anti-thyroid drugs e.g. cRBIMAZOLE OR PROPYLTHIOURACIL
rADIOIODINE THERAPY
tHYROIDECTOMY
Complications of hyperthyroidism?
Thyroid storm : fever, tachycardia, confusion and agitation, nausea and HTN
Management: 4Ps (propylthiouracil, poatssium iodine (lugols), propanolol, prenisolone (steroids)
Atrial fibrillation
Breakdown of thyroid cancer?
Papillary = 80% (young females and good prognosis) Follicular = 10% Medullary = 4% (carcinoma of parafollicular cells), secrete calcitonin and part of MEN 2a/b syndromes
Anaplastic = elderly women and not responsive to treatment. Compression = dysphagia and hoarsness Lymphoma = associated with Hashimotos thyroiditis
Thyroid cancer signs and symptoms?
palpable thryoid nodule, most are cold nodules. COmpression symptoms = hoarsness, dyspnoea and dysphagia and cervical lymphadenopathy
Investigations for thyroid cancer?
TSH, USS neck, FNA biopsy and laryngoscopy
What are the MEN 1 conditions?
Autosomnal dominant 3 P’s
Pituitary tumour (prolactinoma/GH) Parathyroid hyperplasia Pancreatic tumours (gastrinoma, insulinoma, zollinger-ellsion)
What are the MEN 2a conditions?
Mutation in RET
Parathyroid hyperplasia
Phaeochromocytoma (headaches, palpitations,sweating)
Medullary thyroid cancer (increased calcitonin)
What are the MEN2B conditions?
Phaeochromocytoma
Medullary thyroid cancer
Marfinoid habitus
Neuroma
Other tumour markers?
CEA for colon CA15-3 in Breast CA19-3 - pancreatic Calcitonin = medullary thyroid cancer Metenephrines = phaeochromocytoma 5-HIAA in carcinoid tumours alpha-fetoprotein is HCC
WHat is carcinoid syndrome?
Neuroendocrine tumours of the GIT or lungs which secrete serotonin and other vasoactive peptides
Signs and symptoms of carcinoid syndrome?
CARCinoid
Cutaneous flushing
Asthmatic wheeze
Right sided murmur
Cramps + diarrhoea
Palpitations, hypotension and telangiectasia
Investigations for Carcinoid syndrome?
24hr urine collection shows increased 5-HIAA levels (serotonin metabolite)
CT/MRI to localise the tumour
WHat does phaeochromocytoma show in urine?
Increased urinary metanephrones and catecholamines
Signs and symptoms of acromegaly?
Increased GH production secondary to pituitary adenoma.
I look different in photos, my rings and shoes dont fit, headaches.
SPade like hands, clubbed nailes, Carpal tunnels syndrome and high BP
Coarse facial features (bossing, prognathism, diaphoresis, pituitrary enlargmenet signs, macroglossia
Deep voice and sleep apnoea
Complications of acromegaly?
Diabetes, HTN, cardiomyopathy and colorectal cancer. Impaired gluocse tolerance
Ix for Acromegaly?
Serum IGF-1 (1st line)
ral glucose suppresion test
Pituitary MRI
Mx for acromegaly?
Surgery = trans-spenoidal hypophysectomy (1st line)
Medical if sugery unseccessful/inoperable
Medical = 1) somatostatin analogi=ue (octreotide)
2) GH receptor antagonist (pegvisomant)
3) Dopamine agonist (bromocriptine/cabergoline)
Radiotherapy
Hypogonadism Presentation in females?
Delayer puberty, amenorrhoea, infertility, decreased libido, night sweats, hot flushes and dysparenuia, symptoms of cause
Causes of primary female hypogonadism?
Gonadal dysgenesis = Turners
Gonadal damage = radiotherapy, chemo, suergeyr, autoimmune damage
Primary ovarian failure
PCOS
Causes of secondary female hypogondism?
Problem with hypothalamus/pituitary/secondary
Kallmans (failure of GnRH neurone migration = GnRH secretion decrease)
pITUITARY/HYPOTHALMIC PROBLEM E.G. ADENOMA OR HAEMOCHROMOTOSIS
hYPERPROLACTINAEMA
Functional = stress, weight loss and eating disorders
Post OCP
Female signs of hypogonadism and underlying cause?
Pre-pubertal = primary amenorrhoea, no secondary sexual characteristics Post-pubertal = regression of sexual characteristics
Kallmans = anosmia Turners = webbed neck and short stature Hyperprolactinaemia = galactorrhoea, visual field defects
Hypogonadism female Ix?
Pregnancy test
Bloods for decreased oestradiol
Primary = increased LH and FSH
Secondary = decreased LH and FSH
Prolactin and TFTS
primary = genetic testing and pelvic MRI/USS secondary = pituitary funtion tests and MRI
Hypogonadism in Males presentation?
Delayed puberty, erectile dysfunction, infertility, decreased libidio and symptoms of cause
Primary hypogonadism in males causes?
Gonal dysgnesis = Klinefelters Gonadal damage (torsion, irridation, trauma) Post-orchitis (mumps and autoimmune)
Secondary hypogonadism males causes?
Kallmans
Pituitary.hypothalamic lesions
Hyperprolactinaemia
Prader-willi syndrome
Signs of male hypogonadism?
Pre-pubertal = no secondary sex charactersitc Post = hynaecomastia and hair loss
Klinefeleters = low IQ and behavioural Kallmans = anosmia
UIx for male hypogonadism?
Bloods = serum testosterone, SHBG, LH and FSH amnd prolactin
Genetic testing and MRI pituitary
