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CSI yr 2 > Tiredness > Flashcards

Tiredness Flashcards

1
Q

What is the difference between tiredness and fatigue?

A

tiredness -> can be relieved by sleep and rest

fatigue -> tiredness is overwhelming and can’t be relieved by sleep and rest

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2
Q

According to the NHS website, what are the 10 medical reasons that can make you extremely tired?

A
  • Anxiety
  • Anaemia
  • Restless legs
  • Depression
  • Glandular fever
  • Diabetes
  • Chronic fatigue syndrome
  • Coeliac disease
  • Hypethyroidism
  • Sleep Apnoea
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3
Q

Anaemia- what type of anaemia is more common in causing tiredness?

who does it affect most?

A

Iron deficeincy anaemia

It normally occurs in women with heavy periods or pregnant woman- they are prone to anaemia

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4
Q

What type of anaemia can mostly occur in men and postmenopausal women? Explain your reasoning

A

The problem is more likely to be with the stomach and intestines such as ulcers or taking NSAIDs

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5
Q

symptoms of iron deficiency anaemia?

A

you feel like you can’t be bothered to do anything

muscles feel heavy and get tired very quickly

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6
Q

what is the condition where you have too much iron?

what can it cause?

A

iron-overload disorder (haemochromatosis)

can cause tiredness

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7
Q

who does haemochromatosis affect?

A

relatively rare inherited condition that affects men and women between the ages of 30 and 60

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8
Q

what is sleep apnoea?

A

where your throat narrows or closes during sleep

repeatedly interrupts your breathing

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9
Q

what does sleep apnoea result in?

A

This results in loud snoring and a drop in your blood’s oxygen levels. The difficulty in breathing means you wake up often in the night and feel exhausted the next day

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10
Q

who is sleep apnoea most common in?

A

It’s most common in overweight middle-aged men. Drinking alcohol and smoking makes it worse.

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11
Q

what is an underactive thyroid?

A

An underactive thyroid gland means you have too little thyroid hormone (thyroxine) in your body. This makes you feel tired.

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12
Q

symptoms of underactive thyroid?

A

You’re also likely to put on weight and have aching muscles and dry skin. It’s most common in women and happens more often as you get older.

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13
Q

how can a GP diagnose underactive thyroid?

A

blood test

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14
Q

what is chronic fatigue syndrome?

A

Chronic fatigue syndrome (also known as myalgic encephalomyelitis, or ME) is a severe and disabling fatigue that goes on for at least 4 months

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15
Q

symptoms of chronic fatigue syndrome?

A

muscle or joint pain

severe disabling fatigue

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16
Q

what is coeliac disease?

A
  • This is a lifelong disease caused by the immune system reacting to gluten.
  • Gluten is a protein in wheat, barley and rye, and can be found in foods like pasta, bread, cakes and cereals
  • affects in 1 in 100
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17
Q

symptoms of coeliac disease?

A

Other symptoms of coeliac disease, apart from tiredness, are diarrhoea, bloating, anaemia and weight loss. Your GP can do a blood test to check if you may have coeliac disease

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18
Q

symptoms of type 1 and type 2 diabetes?

A

One of the main symptoms of type 1 and type 2 diabetes is feeling very tired.

Other key symptoms are feeling very thirsty, peeing a lot (particularly at night) and weight loss

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19
Q

what is glandular fever?

A

Glandular fever is a common viral infection that causes fatigue, along with fever, sore throat and swollen glands

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20
Q

how long does it take for symptoms of glandular fever to clear up?

A

Symptoms usually clear up within 4 to 6 weeks, but the fatigue can linger for several more months

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21
Q

what is restless leg syndrome?

A

This is when you get an overwhelming urge to move your legs, which can keep you awake at night

You might also have an unpleasant crawling sensation or a deep ache in your legs. Or your legs might jerk spontaneously through the night

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22
Q

how does restless leg syndrome affect your sleep?

A

your sleep will be disrupted and poor quality -> feel tired throughout the day

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23
Q

how can depression make you feel fatigue?

A

make you feel sad

depression can also make you feel drained of energy -> can stop you falling asleep + makes you feel more tired during the day

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24
Q

what is the condition where anxiety strongly affects daily life?

A

But some people have constant uncontrollable feelings of anxiety that are so strong they affect their daily life.

Doctors call this generalised anxiety disorder (GAD)

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25
Q

who does generalised anxiety disorder affect?

A

It’s a common condition, affecting slightly more women than men. As well as feeling worried and irritable, people with GAD often feel tired

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26
Q
A
27
Q

What does thyroxine do?

A

helps to control how fast your body makes and uses energy from food. Your doctor can tell if you have low levels of thyroxine with a blood test

28
Q

why can hypothyroidism occur?

A

autoimmune destruction

damaged by surgery

radiotherapy

some medicines

. Some women develop an underactive thyroid after they give birth. This is often temporary (congenital)

29
Q

symptoms of hypothyroidism?

A

often mild and quite vague:

  • Feeling tired or depressed
  • Thinking more slowly or less clearly than usual
  • Having dry skin
  • Putting on weight
  • Feeling the cold more than usual
  • Having constipation
  • Getting irregular periods, if you’re a woman
30
Q

If underactive thyroid isn’t treated, what symptoms might you notice?

A
  • have very dry, flaky skin
  • have coarse hair, or lose some of your hair
  • put on weight, even though you’re not eating any more food than usual
  • feel depressed
  • feel sluggish and find it difficult to think clearly
  • have a hoarse voice
31
Q

how is an underactive thyroid treated?

A

with hormone tablets -> levothyroxine

32
Q

how long will you need treatment for?

A

possibly for the rest of your life

33
Q

how are you meant to take levothyroxine?

how long might it take for you to notice symptoms improving?

A
  • take one levothyroxine tablet a day on an empty stomach. Most people take it before breakfast.
  • The dose of levothyroxine you take needs to be adjusted carefully to make sure that you don’t have too much. Your doctor will start you on a low dose and gradually increase it. You’ll need regular blood tests to check the dose is right for you.
  • It may take several weeks before you notice any difference in your symptoms. But levothyroxine should make you feel less tired and sluggish. If you were constipated or depressed, these symptoms should also improve
34
Q

what happens if you take too much thyroxine?

A

if dose is too high, might get abnormal heartbeat (atrial fibrillation)

bones might get too thin

35
Q

what might the doctor do to avoid patient taking too much thyroxine??

A

Your doctor will treat you with the lowest possible dose to avoid these problems.

36
Q

what can be the causes of hypothyroidism?

A
  • Autoimmune thyroid disease – The most common form is known as ‘Hashimoto’s thyroiditis’
  • Radioactive iodine treatment, or surgery, to correct hyperthyroidism or to treat thyroid cancer
  • Antithyroid drugs if given for an overactive thyroid disorder in too large a dose
  • Medicines such as lithium (used for certain mental health problems) and amiodarone (used for particular heart problems).
  • Some cough medicines containing large amounts of iodine can also interfere with the way the thyroid functions
  • Some health foods taken in excess, e.g. kelp (seaweed)
  • A malfunction of the pituitary gland (a gland in the brain that regulates the thyroid hormones)
  • Radiation for head and neck cancers (not common in the UK)
  • In a few babies, the thyroid does not develop or does not form the thyroid hormones properly. This is known as congenital hypothyroidism
37
Q

would you notice symptoms of hypothyroidism straight away?

A

The symptoms begin so gradually that you and your doctor might not notice them until the condition is well advanced. Low levels of thyroid hormone result in a slowing down of the mental and physical processes of the whole body

38
Q

symptoms of hypothyroidism?

A
  • Fatigue and tiredness
  • Increased awareness of the cold
  • Dry and coarse skin
  • Dry and thinning hair
  • Hoarse or croaky voice
  • Constipation
  • Muscle weakness, cramps and aches
  • Pins and needles in the fingers and hands (carpal tunnel syndrome)
  • Heavier and longer periods
  • Fertility problems
  • Low libido
  • Weight gain
  • Puffy face and bags under the eyes
  • Slow speech, movements and thoughts
  • Low mood or depression
  • Memory problems
  • Difficulty in concentration
  • Slow heart beat
  • slightly raised blood pressure
  • Raised cholesterol
  • Slowed growth (in children
39
Q

what would the hormone levels likely be like in hypothyroidism?

A

An underactive thyroid is typically associated with a thyroid-stimulating hormone (TSH) level above the reference range and a thyroxine (FT4) level that is below the reference range

40
Q

examinations to test for hypothyroidism?

A
  • physical examination
  • test for thyroid antibodies
  • blood tests
41
Q

what is mild or subclinical hypothyroidism?

A

A blood test result showing a slightly raised TSH level with a normal FT4 level indicates that you may have mild thyroid failure, also known as subclinical hypothyroidism, and that you may have an increased risk of eventually developing hypothyroidism

42
Q

what should you do if you find that you have mild hypothyroidism?

A

You should have a regular thyroid function test and consult your doctor if you notice any symptoms, as you may benefit from treatment.

43
Q

what are the typical doses of levothyroxine?

A

Levothyroxine doses are dependent upon the person’s body weight and their blood test results. Most patients require between 100 and 150mcg a day, but the dose can be lower than 75mcg or up to 300mcg a day, depending on your needs

44
Q

when is levothyroxine best taken?

A

s best taken in the morning, with water, on an empty stomach, at least half an hour before eating and drinking anything. It is also best taken at least four hours apart from calcium, iron, cholesterol-lowering drugs (cholestyramine, colestipol), and multivitamin tablets, as these too can decrease absorption

45
Q

what food is known to increase absorption of levothyroxine and how?

A

Grapefruit on the other hand is known to increase the absorption of levothyroxine as it increases acidity in the stomach. There are a number of other drugs that interact with levothyroxine

46
Q

what happens if a tablet is missed?

A

It is easy to miss a levothyroxine tablet, but because your body has a big reservoir of thyroxine, you will not notice a difference. However, it is important to take the tablets consistently every day as this can affect your blood test results and your health

47
Q

when might levothyroxine tablets deteriorate?

A

Levothyroxine tablets may deteriorate if subjected to extreme temperatures

48
Q

what does the correct dose of levothyroxine result in (hormone level wise)?

A

correct dose of levothyroxine is one that restores good health. In most patients this will be associated with a thyroid-stimulating hormone (TSH) reading in the lower part of the reference range and a level of thyroxine (T4) in the blood towards the upper part or even slightly above the reference range

49
Q

what approach can be taken if patients have complains with levothyroxine despite serum TSH in reference range?

A

Combination therapy of levothyroxine and tri-iodothyronine (LT4 and LT3) may be considered as an experimental approach under the supervision of an accredited endocrinologist but LT3 is not always available on the NHS

50
Q

if you are planning to conceive what should be undertaken?

A

you should let your doctor know and ideally have a blood test before you conceive

51
Q

what is recommended as soon as you know you are pregnant?

A

if you are already taking levothyroxine, it is recommended that the dosage is increased immediately by 25-50mcg daily. You should then arrange to have a thyroid function test as soon as possible

52
Q

will a person have a normal pregnancy if they are on levothyroxine?

A

Even if your thyroid function test is not ideal at the start of pregnancy, your risk of pregnancy complications is only slightly higher than normal and you will still have a good chance of a successful pregnancy outcome. However, your levothyroxine treatment should be adjusted to normalise your thyroid function as soon as possible

53
Q

do thyroid problems run in the family?

A

thyroid problems often run in families and if family members are unwell they should be encouraged to discuss with their own GP whether thyroid testing is warranted

54
Q

what is hashimoto’s disease?

A

autoimmune variant of hypothyroidism

55
Q

what happens to the thyroid in Hashimotos?

A

the thyroid gets infiltrated by white cells and slowly loses its function; it usually enlarges but may not, and may start with an over-active phase before becoming under-active

56
Q

What things can trigger Hashimoto’s disease?

A

Both Graves’ and Hashimoto’s disease can be triggered off by stress factors and also pregnancy. There is a genetic predisposition for both conditions

57
Q

how can you tell if an individual has Hashimoto’s chemically?

A

detected chemically by the presence of antibodies

the rise in TSH

low blood levels of thyroid hormones

58
Q

How does Hashimoto’s present?

A

range of features, two common ones:

goitrous autoimmune thyroiditis

atrophic autoimmune thyroiditis

59
Q

what is Goitrous Autoimmune Thyroiditis?

A
  • progressive infiltration of white cells
  • enlarges the thyroid
  • white cells take over glandular tissue and gland itself becomes mass of fibrous tisse -> follicular cells (where T3 and T4 is made) disappears
  • gland itself is enlarged into a goitre
60
Q

what is Atrophic Autoimmune Thyroiditis?

A
  • thyroid gland shrinking with progressive loss of tissue
  • antibodies block TSH receptors in thyroid
  • glandular tissue shrinks due to lack of use
  • most common form
61
Q

what has been found to worsen autoimmune thyroiditis?

A

increase in dietary iodine

62
Q

why might Hashimoto’s be missed?

A

undue reliance on blood tests

63
Q

why might undue reliance on blood tests lead to Hashimoto’s being missed?

A

T4 is low

T3 may be low as well

both suggests poor thyroid hormone output

normally TSH rises in this situation but, might be normal or low

64
Q

why might TSH be normal or low in Hashimoto’s?

A
  • down-grading of the hypothalamic/pituitary axis due to the state of hypo-metabolism that the low thyroid function induces (This also applies to adrenal function which can also be damaged by autoimmune disease)
  • hypothalamus responds poorly to the low thyroid blood levels, and may not produce a normal level of Thyrotrophin Releasing Hormone (TRH)
  • the pituitary, also affected adversely by the state of hypo-metabolism, may not properly respond to the TRH, and not, therefore, produce a normal level of TSH
  • thyroid -> damaged by white cell infiltration with damaged TSH receptors, may well be less responsive to TSH

CSI yr 2 (3 decks)

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