Thyroid disorders Flashcards
What are 2 auses of hypothyroidism?
Hashimotos thyroiditis
Iodine deficiency
Which drug can induce iodine deficiency?
Amiodarone
Epidemiology of Hashimoto’s thyroiditis
Females > males 45-60 y/o High antibody levels Maternally transmitted May be preceded by transient hyperfunction
Pathogenesis of Hashimoto’s thyroiditis
CB+ve cells may mediate destruction of thyroid epithelium (y interferon from T cell activation recruits macrophages)
How is Hashioto’s thyroiditis characterised?
Presence of thyroid peroxidase antibodies
T cell infiltrate
Hair/skin symptoms of hypothyroidism
Sparse, coarse hair Pale cool doughy skin Perioribtal puffiness Vitiligo Dull expresionless face
Cardiac symptoms of hypothyroidism
Decreased HR
Pericardial effusion
Cardiac dilation
Resp symptoms of hypothyroidism
Deep hoarse voice
Sleep apnoea
Macroglossia
Neuro symptoms of hypothyroidism
Carpal tunnel
Stiffness, cramps
Peripheral neuropathy
Decreased visual
GI symptoms of hypothyroidism
Constipation
Megacolon
Intestinal obstruction
Ascites
Gynae symptoms of hypothyroidism
Menorrhagia
Oligo/amenorrhoea
Hyperprolactinaemia
Metabolic symptoms of hypothyroidism
Pitting oedema
Decreased appetite
Weight gain
Biochemical findings of hypotyhroidism
HIGH TSH LOW T3/4 High CK High LDL Low sodium
Management of hypothyroidism
Thyroxine (start low go slow) - taken before breakfast
What is the risk of overzealous immediate thyroxine treatment of hypothyroidism?
Arrhythmia;s
Causes of hyperthyroidism
Graves
Modular (multi-nodular goitre, toxic adenoma)
Thyroiditis (post partum)
Iodine
How does toxic adenoma tend to present?
Older patients
Insidious onset
Assymetrical goitre
How does Graves disease tend to present?
Females > males
Smoking
Smooth symmetrical goitre
Cardiac symptoms of hyperthyroidism
Palpitations/AF Cardiac failure (rare)
CNS symptoms of hyperthyroidism
Tremor
Sweating
Anxiety
Sleep disturbance
Reproductive symptoms of hyperthyroidism
Lighter less frequent periods
Metabolism symptoms of hyperthyroidism
Weight loss
Appetite gain
GI symptoms of hyperthyroidism
Frequent loose stools
Visual symptoms of hyperthyroidism
Bulgin eyes
Double vision
Hair/skin symptoms of hyperthyroidism
Thin brittle hair
Rapid fingernail growth
Muscle symptoms of hyperthyroidism
Muscle weakness - thighs + upper arms
Treatment of hyperthyroidism
Carbimazole
Propathiouracil
Radioiodine
Biochemical features of Hyperthyroidism
LOW TSH
HIGHT T3/4
Side effect of carbimazole
Agranulocytosis
Levels of TSH aimed for in pregnancy
1st trimester
First line investigation of neck lump
Ultrasound
Changes in thyrosine dose in pregnancy
+25%
Hyperthyroidism in pregnancy
1st trimester - propathiouracil
2nd/3rd trimester - carbimazole
