Thyroid + Paraythroid pathology Flashcards
S+S hyperparathyroidism
Asymptomatic hypercalcaemia Bone pain Renal calculi Muscle weakness Proximal myopathy N+V Constipation Polyuria/ dipsia
Blood results for hyperparathyroidism
High calcium
High PTH
Low phosphate
Causes of hyperparathyroidism
Hyperplasia
Adenoma
Carcinoma
Treatment of hyperparathyroidism
Surgery - parathyroidectomy
Bisphosphonates or cinacalcet
Vitamin D
Grave’s disease features
Thyroid acropachy Eye disease Pretibial myxoedema TSH receptor Ab Proximal myopathy Hyperthyroidism S+S
Mechanism of hyperthyroidism
Reduced TRH causes low TSH
Raised T3 + T4
Management of hyperthyroidism
Carbimazole
Beta blockers
Management of hypothyroidism
Levothyroxine
Mechanism of thyroid gland
Gland releases T4 (thyroxine) which is converted to T3
Controlled by TSH which is released by pituitary
S+S parathyroid adenoma
Hyperparathyroidism: bone fractures, kidney stones, polyuria
Depression, N+V, myalgia, abdo pain
Investigation results for parathyroid adenoma
Raised PTH
Abnormal calcium + phosphate
What are the S+S of congenital hypothyroidism?
hypotonia, coarse facial features, hoarse cry, prolonged jaundice, umbilical hernia
Types of hyperthyroidism
Primary = abnormality of thyroid gland such as Graves Secondary = abnormal stimulation of thyroid gland by TSH secreting pituitary tumor
Complications of hyperthyroidism?
o Graves' orbitopathy. o Thyroid storm (thyrotoxic crisis). o Atrial fibrillation. o Heart failure. o Reduced bone mineral density. o Increased mortality rate.
S+S of hyperthyroidism
Symptoms of hyperthyroidism include:
o Breathlessness, dysphagia, neck pressure — may be caused by a toxic multinodular goitre.
o Palpitations, anxiety, exercise intolerance, fatigue, muscle weakness.
o Heat intolerance, increased sweating.
o Increased appetite with weight loss, diarrhoea.
o Note: older people may present with atypical or few symptoms.
Signs of thyrotoxicosis include:
o Agitation, fine tremor, warm moist skin, palmar erythema.
o Sinus tachycardia, atrial fibrillation, heart failure, dependent oedema.
o Eye signs (lid lag or retraction).
o Goitre (may be diffuse, multinodular, or single nodule). A tender, irregular thyroid gland may suggest subacute thyroiditis.
What markers should be checked in subacute hyperthyroidism?
CRP + ESR
Types of hypothyroidism
Primary = high TSH + low T4, due to iodine deficiency or abnormal gland (autoimmune (Hashimotos) or damage to gland from surgery or RT Secondary = insufficienct TSH due to pituitary or hypothalamic disorder
What is postpartum thyroiditis?
Thyrotoxicosis or hypothyroidism within a year of giving birth
Complications of hypothyroidism
CV: dyslipidiemia, CHD, HF
Repro: reduced fertility, miscarriage, congenital abnormalities
Neuro: deafness, impaired concentration + memory
Myxoedema coma
S+S of hypothyroidism
Symptoms: fatigue/lethargy, cold intolerance, weight gain, weakness, arthralgia and myalgia, constipation, menstrual irregularities, depression, and cognitive impairment.
Signs include hair loss, coarse dry hair and skin, oedema, goitre, bradycardia, diastolic hypertension, and delayed relaxation of deep tendon reflexes
What are the causes of hypercalcaemia?
Malignancy (breast, lung, multiple myeloma)
Hyperparathyroidism
Thiazides, lithium, TB, sarcoidosis, CKD
S+S of hypercalcaemia
Bone pain + fractures Drowsiness, delirium, muscle weakness, depression N+V, constipation, abdo pain Polyuria + dipsia, dehydration HTN, shortened QT Itching, keratitis, conjunctivities
Initial management of bloods with high calcium
Check PTH levels If high = hyperparathyroidism If low = malignancy Consider: CXR Renal function + U+E FBC Urine protein electrophoresis (MM) LFTs TFTs Serum cortisol
How does hypercalcaemia of malginancy occur?
Tumor secretion of PTH-related protein
Osteolytic mets with release of cytokines
Tumor production of vit D
