Thyroid disorders Flashcards
Systems affected by thyroid disease
- energy
- weight
- temp
- heart
- nervosu ssytem
- GI system
- MSK
- SKIN
Energy
Hypo-
Hyper-
Hypo- low
Hyper- high
Weight
Hypo-
Hyper-
Weight
Hypo- increase
Hyper- loss
Temperature
Hypo-
Hyper-
Hypo- cold
Hyper- heat intolerant
Heart
Hypo-
Hyper-
Hypo- bradycardic
Hyper- tachycardic
Nervous system
Hypo-
Hyper-
Hypo- lethargic
Hyper- hypersensitive/ nervous irritability
GI system
Hypo -
Hyper-
Hypo - constipated
Hyper- more frequent bowels
MSK
Hyper-
shake on outstretched movement
Skin
Hypo-
itching
blood test results of primary hypothyroidsm
T4 low (2.4 pmol/L (8-25)
TSH high (150 miU/L (1-4.5)
blood test results of primary hyperthyroidsm
T4 high (86 pmol/L (8-25)
TSH low (<0.05miU/L (1-4.5)
thryoid exam
Can only feel if enlarged
Feeling for nodules and perfuse swellings
Ask patient to swallow
radioisotope scan
Give Technetium-99m via IV- a good uptaker of iodine (inject)
Can see gland activity
thyroid ultrascan
best way- structural scan
plain X-ray and CT scan
old fashioned word for hypothyroidism
myxoedema
Swelling of eyes and thickened skin
symptoms of hypothyroidism
Symptoms
Tiredness
Weight gain
Cold intolerance
Change in appearance
Depression
Psychosis
Joint/ muscle ache
Dry hair/ skin
Constipation
Puffy eyes
signs of hypothyroidism
Peri-orbital oedema- swelling of the eyes
Loss of lateral eyebrows
Dry, thin hair
Bradycardia
Slow-relaxing reflexes
Carpal tunnel syndrome
Cold peripheries
causes of hypothyroidism
Autoimmune atrophic
Hashimotos’ thyroiditis
Post-partum thyroiditis
Dyshormonogenesis (babies born with under active thyroid)
Medication
Iodine deficiency
children of iodine deficient mother
all children have hypothyroidism
- reduced IQ- cretinism
Special situations in hypothyroidism
Myxoedema coma
Borderline or sub-clinical hypothyroidism
Myxoedema coma
Severe hypothyroidism usually in the elderly.
Hypothermia and fluid overload in heart
50% mortality
Borderline or sub-clinical hypothyroidism
Low/normal T4 and high TSH
More common than severe hypothyroidism
Can be monitored until symptoms warrant treatment
treartment of hypothyroidism
Thyroxine replacement therapy
Thyroxine replacement therapy
Levothyroxine (T4) for life
Starting dose depends on severity
100ug for young and fit person
More caution in elderly and heart disease
aim of treatment with Thyroxine replacement therapy
Resolution of symptoms
Normalisation of blood tests (6-8 weeks)
High TSH suggests under replacement
Low TSH suggests over replacement
symptoms of hyperthryoidism
Weight loss
Irritability
Restlessness
Insomnia
Malaise
Itching
Sweating
Palpitation
Tremor
Muscle ache
Diarrhoea
signs of hyperthyroidism
Tremor
Hyperkinesis
Tachycardia
Atrial fibrillation (irreg irreg)
Warm peripheries
Hypertension
Proximal myopathy
Lid lag
lid lag and hyperthyroidism
Causes of hyperthryoidism
Graves disease
Nodular thyroid disease
Thyroiditis
graves disease
effects of graves
Graves ophthalmopathy
Pretibial myxoedema (Graves dermopathy)
Thyroid acropathy
Thyroiditis
Inflammation of thyroid
Release of thyroxine into circulation
causes of thyroiditis
- Viral infection- de quervains thyroiditis
- After birth- post partum
- Medication- amiodarone
nodular hyperthryoidism- single toxic nodule
nodular hyperthryoidism- multi-nodular goitre
Special situations in hyperthyroidism
Thyroid crisis or thyroid storm
Hyperthyroidism and pregnancy
Thyroid crisis or thyroid storm
Rare condition with 10% mortality
Hyperpyrexia
Tachycardia
Cardiac failure
Liver dysfunction
Urgent treatment
Hyperthyroidism and pregnancy
- In graves disease antibodies can cross placenta
- Baby can be born with hyperthyroidism
- Requires close monitoring in pregnancy
treatment for hyperthryoidism
medication, surgery or radioactive iodine
medication for hyperthyroidism
- Carbimazole
- Beware of agranulocytosis (reduces neutrophils)
- Beta blocker for symptom control
Surgery for hyperthyroidism
- If side effects on medication or patient preference
- Good cosmetic results
- Small risk of laryngeal nerves palsy’s and hypocalcaemia
Radioactive iodine in treatment of hyperthyroidism
Good definitive non-surgical option
Contra-indicated in pregnancy
Radiation restriction guidance after treatment
most goitees caused by thyroid nodules are in
women (7%)
men (1%)
Types of goitre
Diffuse goitre
Simple goitre
Auto-immune
Thyroiditis
Nodular goitre
Multinodular goitre
solitary nodule (red flag )
Fibrotic goitre
Riedel’s thyroiditis – rare
Iodine deficiency
Common worldwide
Rare in UK
Red flag symptoms of thyroid cancer: History
- Very young or old patient
- Rapid enlargement of lump in neck
- Hoarse voice and dysphagia
- Family history of thyroid cancer
Red flag symptoms of thyroid cancer: examination
- Hard irregular thyroid mass
- Fixed to surrounding structures
- Cervical lymph nodes
Investigation of suspected thyroid cancer
Thyroid ultra sound
Fine need aspiration
CT scan thorax and mediastinum
if cytology suggests cancer
- Surgical removal
- Prognosis is good
