Thyroid disease Flashcards
symptoms of thyrotoxicosis
diarrhoea, weight loss, appetite increase,sweats, heat intolerance, palps, tremor, irritable. rare- pyschosis, chorea
signs of thyrotoxicosis
pulse fast/irregular, warm moist skin, fine tremor, palmar erythema, lid lag, lid retraction, goitre, thyroid nodules, bruits
what is Graves disease, typical age and male to female ratio
hyperthyroidism, 40-60 years, 9:1 female:male
signs of Graves disease
exophthalmos, opthalmoplegia, pretibial myxoedema, clubbing, painful finger and toe swelling, periosteal reaction in limb bones
tests for thyrotoxicosis
TSH down, T4 and T3 up. mild normocytic anaemia, mild neutropenia, ESR up, Ca up, LFT up
cause of Graves
circulating IgG autoantibodies bind to and activate GPCR thyrotropin receptors- smooth thyroid enlargement and increased hormone production
triggers of Graves
stress, infection, childbirth
what are the causes of thyrotoxicosis
Graves, toxic multinodular goitre, toxic adenoma, ectopic thyroid tissue, exogenous (iodine excess, levothyroxine excess).
what are the diffuse causes of goitre
physiological, Graves, Hashimotos thyroiditis, subacute (de Quervain’s) thyroiditis
what are the nodular causes of goitre
multinodular goitre, adenoma, carcinoma
how can you treat thyrotoxicosis
drugs- b blockers, carbimazole; radioiodine (CI- pregnancy, lactation); thyroidectomy
complications of thyrotoxicosis
heart failure (thyrotoxic cardiomyopathy), angina, AF, osteoporosis
how many Graves patients present with thyroid eye disease and what is the main known risk factor
25-50%. smoking
what is the medical emergency associated with hyperthyroidism
thyroid storm
what are the manifestations of Graves- heart
incr rate, incr contractility
what are the manifestations of Graves- liver
incr peripheral T3, decr LDL
what are the manifestations of Graves- bone
incr bone turnover, osteoporosis
what are the manifestations of Graves- genital
male- decr libido and erectile dysfunction, female- irregular menses
what are the manifestations of Graves- metabolic, fat
thermogenesis, incr O2 use; decr fat mass
what are the manifestations of Graves- CNS
stiff person syndrome
what are the manifestations of Graves- muscle
proximal myopathy
what are the manifestations of Graves- thyroid
incr secretion T3 and T4
more common age and gender of hypothyroidism
> 40 years, female 6:1
symptoms of hypothyroidism
tired, sleepy, lethargic, mood decr, cold disliking, weight incr, constipation, hoarse voice, decr memory, dementia, myalgia, weakness
signs of hypothyroidism
BRADYCARDIC- Reflexes relax slowly, Ataxia, Dry thin hair/ skin, Yawning/drowsy/coma, Cold hands, Ascites +/- non pitting oedema, Round puffy face, Defeated demeanour, Immobile, CCF. neuropathy, myopathy, goitre
diagnosis of hypothyroidism
TSH incr T4 decr
causes of primary autoimmune hypothyroidism
primary atrophic hypothyroidism; Hashimotos thyroiditis
what is Hashimotos thyroiditis
goitre due to lymphocytic and plasma cell infiltration
what is the main cause of hypothyroidism worldwide
iodine deficiency
what are the causes of primary hypothyroidism
iodine deficiency, post thyroidectomy or radioiodine treatment, drug induced, subacute thyroiditis
what occurs in secondary hypothyroidism
not enough TSH, rare, hypopituitarism
what are the pregnancy problems associated with hypothyroidism
eclampsia, anaemia, prematurity, decr birthweight, stillbirth, PPH
what are the associated conditions with hypothyroidism
Turners, Downs, CF, primary biliary cirrhosis
what is the treatment for hypothyroidism
levothyroxine (T4).
