Thyroid Disease (2*) Flashcards
Hyperthyroidism:
What is Thyrotoxicosis?
How does it present?
Which features suggest Grave’s disease?
What are its complications?
➊ Syndrome caused by excess thyroid hormones in the body. However, it’s usually caused by a sudden release of these stored hormones rather than gland overactivity.
➋ • Weight loss
• Diarrhoea
• Tachycardia/AF
• Palpitations
• Oligo/Amenorrhoea
• Heat intolerance
• Hair loss
• Irritability
• Muscle weakness
• Insomnia
➌ Exophthalmos, Ophthalmoplegia, Periorbital oedema, Pretibial Myxoedema (waxy skin)
➍ Thyroid storm, AF, HF, Osteoporosis, Upper airway obstruction if large goitre, Corneal ulcers/visual loss
What is its most common cause?
→ What occurs here?
What are its other causes?
➊ Grave’s disease
→ Autoimmune production of TSH receptor antibodies, which mimic TSH and stimulate its receptors, leading to primary hyperthyroidism
➋ * Toxic multinodular goitre
* Solitary toxic adenoma
* Acute thyroiditis (e.g. De Quervain’s) - painful goitre
* Amiodarone, Lithium
* Choriocarcinoma
Management:
What are the 1st line things to give?
→ What’s the main SE to know for this antithyroid drug?
What is the other medical option?
→ Who should it be avoided in? Why?
When is Thyroidectomy an option?
→ What are its complications?
What are all pts at risk of when being managed?
➊ • B-blocker (e.g. propranolol) for symptomatic relief
• Carbimazole or Propylthiouracil - titration-block or block and replace regimens
→ Agranulocytosis
N.B. Propylthiouracil better option in early pregnancy
➋ Radioactive Iodine
→ Those with Grave’s eye disease as it many worsen it
➌ If compression or malignancy is suspected
→ Hypoparathyroidism (hypocalcaemia), Recurrent laryngeal nerve damage (hoarse voice)
➍ Hypothyroidism, therefore required Levothyroxine
Hypothyroidism:
How does it present?
• Weight gain
• Constipation
• Bradycardia
• Menorrhagia
• Cold intolerance
• Loss of lateral 1/3 of eyebrow
• Memory loss
• Puffy face
• Fluid retention (edema, pleural effusions, ascites)
What’s its most common cause?
→ What’s it associated with?
What are its other causes?
What is its secondary cause?
➊ Hashimoto’s Thyroiditis (autoimmune inflammation of thyroid)
→ Anti-TPO, anti-thyroglobulin, anti-TSH receptor
➋ • Iodine Deficiency
• Drugs - Amiodarone, Lithium
• Post-hyperthyroid treatment - Carbimazole, Radioactive iodine, Thyroidectomy
➌ Hypopituitarism (less TSH) - due to tumour, infection, radiation, sheehan syndrome
With investigations, how can primary type be differentiated from secondary type?
How is it managed?
➊ • Primary - Low TH, High TSH
• Secondary - Low TH, Low TSH
➋ Levothyroxine
Sick Euthyroid:
What is this?
Why does it occur?
➊ Low TH levels in pts who are ill/starved, but are normally euthyroid.
➋ In periods of illness or starvation, the body enters a catabolic state in which breaks down it’s own proteins for energy. When the stores for energy run out, the body then stops producing as many proteins. One of these proteins are the THs, therefore leading to a deficiency. It’s managed by treating the underyling cause.
