Thyroid disease Flashcards
History for Hyper and Hypo thyroidism
Hyper: Dirrhoea, decreased weight, increased appetite, over-activity, sweats, heat intolerance, palpitations, tremor, irratibility, labile emotions, oligomenorrhoea +/- infertility
Hypo: sleepy, tired, lethargic, low mood, cold-dislike, increased weight, constipation, menorrhagia, hoarse voice, decreased memory, myalgia, cramps
Examination of hyper/hypo
Hyper: warm moist skin, fine tremor, tachycardia, arrhythmia (AF, SVT), thin hair, lid lag, lid retraction
graves: exopthalmos, ophthalmoplegia, pretibial myxodema, hyperreflexia, proximal myopathy, carpel tunnel - test VA and VFs
Hypo: cool dry palms, bradycardia, pallor, dull expression, puffy eyes, thin hair, goitre (diffuse or multinodular), retrosternal dullness, pemberton’s sign, slow relaxing pulses
Investigations:
T3, T4, TSH
Antibodies: Anti-TPO, TSH receptor AB
Ultrasound: cystic/solid, single/multi
Isotope scan: cause
Causes of hyper/hypo
Hyper:
- Graves - IgG anti TPO ABs
- Toxic MNG
- Toxic Adenoma
- Thyroiditis - Hashimoto’s, post partum, post viral
- Drugs - amiodarone, levothyroxine
Hypo:
- Acquired -iodine deficiency, iatrogenic
- Autoimmune - pimary atrophic, hashimoto’s (TPO AB)
- Inflammatory - post partum, SADQT (post-viral)
- Secondary - hypopituitarism
Management of Hyperthyroidism
Drugs:
- propanalol for palpitations
- carbimazole (15mg BD) or propylthiouracil (150mg BD) - titrated to TFTS then withdraw SE: agranulocytosis
Radioiodine
Thyroidectomy
Management of hypothroidism
Levothyroxine (T4) - 50-100 micrograms OD, checking TSH at 12 weeks and then 6-weekly
If IHD or elderly start at 25 micrograms
Liothyroxine (T3) - small group of patients are deficient of 5’deiodinase and cant convert T4 to T3
Complications Hyper/Hypo:
Sever Hyper: thyrotixic periodic paralysis + thyroid storm (fever, > 200bpm), HF, Angina, AF, osteoporosis, ophthalmopathy, gynaecomastia
Hypo: pregnancy problems (eclampsia, anaemia, prematurity), heart disease, dementia
