Week 3 - A 22 year old woman with palpitations and anxiety Flashcards
What further information would you like from the history and why?
What abnormal physical sign can you see in the image? What else would you look for on physical examination and why?
What would you like to do now? (ixs?)
What is the diagnosis?
What is the diagnosis?
What are the antithyroid medication options for hyperthyroidism?
Discuss radioiodine therapy for hyperthyroidism?
Discuss surgical therapy for hyperthyroidism?
Define:
- Thyrotoxicosis?
- Hyperthyroidism? Overt vs. Subclinical?
What is the Epidemiology of Hyperthyroidism?
- Prevalence?
- Sex?
- Ages?
Aetiology of Hyperthyroidism:
- 5 causes of hyperfunctioning thyroid gland?
- 6 causes of destruction of thyroid gland?
- 2 causes of Ectopic hormone production?
Explain the pathophysiology of hypothalamic-pituitary-thyroid axis in hyperthyroidism?
Explain the effects/pathophysiology of thyrotoxicosis?
Clinical Features of Hyperthyroidism:
- 5 General?
- 3 Skin?
- 3 Goiter?
- 6 CVS?
- 3 Musculoskeletal?
Clinical Features of Hyperthyroidism:
- Endocrinological: female? male?
- 7 Neuropsychiatric?
Diagnostic approach to Hyperthyroidism?
What is involved in the initial testing for thyroid disorder?
How are thyroid disorders classified?
List some drugs that influence thyroid hormones in the following ways.
What is Hashimoto Thyroiditis?
Pathogenesis of Hashimoto thyroiditis?
Figure 24.10 Pathogenesis of Hashimoto thyroiditis. Breakdown of peripheral tolerance to thyroid autoantigens results in progressive autoimmune destruction of thyroid cells by infiltrating cytotoxic T cells, locally released cytokines, or antibody-dependent cytotoxicity.
Clinical features of Hashimoto thyroiditis?
What is Subacute Lymphocytic (Painless) Thyroiditis?
Morphology?
Subacute Lymphocytic (Painless) Thyroiditis - Clinical Features?
Granulomatous Thyroiditis - Pathogenesis?
Granulomatous thyroiditis - Clinical Features?
Hypothyroidism
- Different types?
- Typical symptoms?
- Effect of medications?
Primary Hypothyroidism
- Overt vs. Subclinical?
- 4 groups of people it is more common in?
- Most common cause?
What is Primary hypothyroidism treated with?
When should you start treatment?
- in Overt symptomatic primary hypothyroidism?
- in Overt asymptomatic primary hypothyroidism?
- in Subclinical symptomatic primary hypothyroidism?
- Subclinical asymptomatic primary hypothyroidism?
What are the 2 strategies for Thyroxine replacement therapy in adults? Which doses?
Thyrotoxicosis:
- Causes?
- Symptoms?
- Complications?
Graves disease
- clinical presentation and course of disease?
- expected investigation findings?
- pathophysiology?
- treatment?
toxic multinodular goitre
- clinical presentation and course of disease?
- expected investigation findings?
- pathophysiology?
- treatment?
toxic adenoma
- clinical presentation and course of disease?
- expected investigation findings?
- pathophysiology?
- treatment?
painful subacute thyroiditis
- clinical presentation and course of disease?
- expected investigation findings?
- pathophysiology?
- treatment?
painless sporadic thyroiditis
- clinical presentation and course of disease?
- expected investigation findings?
- pathophysiology?
- treatment?
Amiodarone-induced thyrotoxicosis
- clinical presentation and course of disease?
- expected investigation findings?
- pathophysiology?
- treatment?
TGA Guidelines - Antithyroid drug therapy for primary hyperthyroidism?
Primary hyperthyroidism (ie Graves disease, toxic multinodular goitre, toxic adenoma) is usually managed initially with an antithyroid drug with the aim of achieving euthyroidism. Some patients can achieve remission with an antithyroid drug alone (eg patients with mild Graves disease), while other patients use an antithyroid drug in preparation for definitive treatment (ie radioiodine or thyroidectomy). Antithyroid drugs gradually relieve the symptoms of thyrotoxicosis as the patient becomes euthyroid. In the interim, beta-blocker therapy can be used for symptomatic patients to rapidly improve symptoms.
What is Graves’ Disease?
Pathogenesis of Graves’s Disease?
Clinical Features of Graves’ Disease?
- Treatment?
Graves disease is treated with β-blockers, which dampen symptoms related to increased sympathetic nervous system activity (e.g., tachycardia, palpitations, tremulousness, and anxiety), and by measures that decrease thyroid hormone synthesis, such as the administration of thionamides (e.g., propylthiouracil), radioiodine ablation, and thyroidectomy. Surgery is used mostly in patients who have large goiters that are compressing surrounding structures.
