Thyroid/ Cushings/ Addisons Flashcards

1
Q

Does Hashimoto’s thyroiditis cause hypo or hyper

A

Hypo
However, in acute phase can het hyper before hypo

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2
Q

Does Hashimoto’s present with a goitre?

A

Yes, usually PAINLESS

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3
Q

Antibodies associated with Hashimoto’s

A

Anti TPO, anti TG

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4
Q

Most common cause of hypothyroidism in children

A

In the developed world: Autoimmune thyroiditis

In the developing world: Iodine deficiency

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5
Q

What cancer is Hashimoto’s associated with the development of?

A

MALT lymphoma

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6
Q

Does graves cause hypo or hyper

A

Hyper

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7
Q

Most common cause of thyrotoxicosis

A

Graves

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8
Q

What features do you get in graves but not other forms of thyrotoxicosis?

A

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

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9
Q

Antibodies associated with graves

A

Anti TPO
TSH receptor stimulating antibodies (

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10
Q

What would TFTs look like in sick euthyroid?

A

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

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11
Q

Is subacute thyroiditis hypo or hyper?

A

Hyper.

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12
Q

4 phases of subacute thyroiditis

A

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

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13
Q

what is subclinical hypothyroidism?

A

TSH high, T3/T4 normal.

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14
Q

How to manage subclinical hypothyroidism

A

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.

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15
Q

What will electrolytes be doing in Addisons?

A

Low sodium, high potassium.

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16
Q

What is Addisons?

A

Where you get destruction of the adrenal glands so low cortisol and aldosterone.

17
Q

Most common cause of Addisons in UK?

A

Autoimmune

18
Q

How to diagnose Addisons

19
Q

What do you do with Addisons treatment in acute illness?

A

Addison’s patient with intercurrent illness → double the glucocorticoids, keep fludrocortisone dose the same

20
Q

What would suggest phaeochromocytoma?

A

Triad of palpitations, sweating and headaches in association with severe hypertension

21
Q

How to Ix pheochromocytoma

A

urinary metanephrines.

22
Q

What is a pheochromocytoma?

A

Catecholamine (adrenaline) producing tumour on bac of adrenal medulla

23
Q

How would primary hyperaldosteronism present?

A

Hypokalaemia, hypernatraemia, raised bp

24
Q

What is primary hyperaldosteronism?

A

Bilateral adrenal hyperplasia

25
How is primary hyperaldosteronism different to Conns?
Conns = adrenal adenoma. Conns is less common)
26
How to Ix primary hyperaldosteronism?
plasma aldosterone/renin ratio is the first-line investigation - will get high aldosterone low renin Then HRCT
27
How to manage primary hyperaldosteronism
Chop it out Spiro (aldosterone antagonist)
28
Which drugs can you give in Graves that are safe in pregnancy?
Carbimazole but NOT safe pre conception/ first trimester Propylthiouracil is safe.
29
How to diagnose acromegaly
insulin like GF 1 (this is better than GH). If +ve then OGTT with serial GHs
30
Do you get galactorrhea with acromegaly?
yes
31
What is acromegaly caused by
Pituitary adenoma
32