Thyroid/ Cushings/ Addisons Flashcards
Does Hashimoto’s thyroiditis cause hypo or hyper
Hypo
However, in acute phase can het hyper before hypo
Does Hashimoto’s present with a goitre?
Yes, usually PAINLESS
Antibodies associated with Hashimoto’s
Anti TPO, anti TG
Most common cause of hypothyroidism in children
In the developed world: Autoimmune thyroiditis
In the developing world: Iodine deficiency
What cancer is Hashimoto’s associated with the development of?
MALT lymphoma
Does graves cause hypo or hyper
Hyper
Most common cause of thyrotoxicosis
Graves
What features do you get in graves but not other forms of thyrotoxicosis?
eye signs (30% of patients)
exophthalmos
ophthalmoplegia
pretibial myxoedema
thyroid acropachy, a triad of:
digital clubbing
soft tissue swelling of hands and feet
periosteal new bone formation
Antibodies associated with graves
Anti TPO
TSH receptor stimulating antibodies (
What would TFTs look like in sick euthyroid?
it is often said that everything (TSH, thyroxine and T3) is low. In the majority of cases however the TSH level is within the >normal range
Is subacute thyroiditis hypo or hyper?
Hyper.
4 phases of subacute thyroiditis
phase 1 (lasts 3-6 weeks): hyperthyroidism, painful goitre, raised ESR
phase 2 (1-3 weeks): euthyroid
phase 3 (weeks - months): hypothyroidism
phase 4: thyroid structure and function goes back to normal
what is subclinical hypothyroidism?
TSH high, T3/T4 normal.
How to manage subclinical hypothyroidism
TSH more than 10, free thyroxine normal - Repeat in 3 months. If TSH remains above 10 then consider offering levothyroxine.
TSH 5.5 - 10, free thyroxine normal - Repeat again in 3 months.
if < 65 and its the same when repeated, AND there are sx of hypo, consider offering a 6-month trial of levothyroxine.
In older people ‘watch and wait,’ rat in 6 months.
What will electrolytes be doing in Addisons?
Low sodium, high potassium.
What is Addisons?
Where you get destruction of the adrenal glands so low cortisol and aldosterone.
Most common cause of Addisons in UK?
Autoimmune
How to diagnose Addisons
SST
What do you do with Addisons treatment in acute illness?
Addison’s patient with intercurrent illness → double the glucocorticoids, keep fludrocortisone dose the same
What would suggest phaeochromocytoma?
Triad of palpitations, sweating and headaches in association with severe hypertension
How to Ix pheochromocytoma
urinary metanephrines.
What is a pheochromocytoma?
Catecholamine (adrenaline) producing tumour on bac of adrenal medulla
How would primary hyperaldosteronism present?
Hypokalaemia, hypernatraemia, raised bp
What is primary hyperaldosteronism?
Bilateral adrenal hyperplasia
How is primary hyperaldosteronism different to Conns?
Conns = adrenal adenoma. Conns is less common)
How to Ix primary hyperaldosteronism?
plasma aldosterone/renin ratio is the first-line investigation - will get high aldosterone low renin
Then HRCT
How to manage primary hyperaldosteronism
Chop it out
Spiro (aldosterone antagonist)
Which drugs can you give in Graves that are safe in pregnancy?
Carbimazole but NOT safe pre conception/ first trimester
Propylthiouracil is safe.
How to diagnose acromegaly
insulin like GF 1 (this is better than GH).
If +ve then OGTT with serial GHs
Do you get galactorrhea with acromegaly?
yes
What is acromegaly caused by
Pituitary adenoma
