E2 - Thyroid disorders Flashcards
(37 cards)
What is thyreotoxicosis?
biochemical reactions and pathophysiological changes triggered by overproduction of thyroid hormone
What are the diseases of hyperthyreodism?
- Graves disease
- nodular autonomous hormone-producing adenomas
- thyroid inflammations
- well differentiated thyroid tumor
What are the general symptoms of hyperthyroidism?
- hot intolerance
- sweating
- agitation
What are the skin symptoms of hyperthyroidism?
- hair loss, hair thinning
- “Plummer’s nails” (softening and become detached)
- pigment disorders
What are the muscular system symptoms of hyperthyroidism?
- weakness
- fatigue
- proximal myopathy
What are the cardiac symptoms of hyperthyroidism?
- accelerated circulation: resting tachycardia, systolic, hypertension, agina pectoris
- 10-20% afib
- mitral prolapse becomes more pronounced
- cardiomyopathy may develop
What are the respiratory symptoms of hyperthyroidism?
- tracheal constriction
- difficulty breathing
- weakness of resp. muscles
What are the gastrointestinal symptoms of hyperthyroidism?
- weight loss with good appetite
- frequent, softer stools
- in sever disease: nausea, vomiting, liver enzyme elevation
What are the skeletal symptoms of hyperthyroidism?
- accelerated bone metabolism
- coritcal bone detachment, fragility
- moderate hypercalcemia may develop
What are the hematological symptoms of hyperthyroidism?
- RBC production increases
- increase in plasma volume
What are the hormonal changes in case of hyperthyroidism?
FSH/LH changes resulting in oligoraro menorrhea, loss of libido, impotence, infertility
What are the metabolic changes in hyperthyroidism?
- cholesterol decreases, HDL increases
- insulin secretion and resistance increases (impaired glucose tolerance)
What are the nervous system symptoms of hyperthyroidism?
- agitated, restless, anxious
- depression
- insomnia
- rapid/erratic thinking
- deterioration of cognitive functions
- hypermotile but fatigable
- hand, body-wide fine wave tremors
- increased risk of developing dementia
- in sever cases: psychosis-like clinical picture
What are the opthalmological symptoms of hyperthyroidism?
- shiny and dilated eyes
- stiff eyes
- slow blinking
What is Graves disease?
- autoimmune disease: antibody against TSH receptor is produced
- predisposing factors: female; genetic; infection (yersinia enterocolica); psychological stress; good iodine supply; smoking
- its course is extremely erratic!!
clinical picture:
- diffuse goitre
- TSH is very low, increased fT3 and fT4
- consistent enrichment on scintigram
What are the specific symptoms for Graves disease?
- skin: vitiligo, alopecia, pretibial infiltrative dermopathy
- eye: exophthalmos, eye movement disorder, periorbital and conjunctival edema
- gastrointestinal: achlorhydria, celiac disease
- muscular: 1% of patients w/ myasthenia gravis
- hematology: relative lymphocytosis (low WBC count)
What is toxic nodular goitre?
- somatic mutation of TSH receptor or Gs subunit
- predisposing factors: >40 years, iodine deficiency
clinical picture:
- nodular goitre (one or more nodules)
- TSH is very low, very high fT3, and high fT4
- nodular enrichment on scintigraphy
What is iodine-induced hyperthyroidism?
- high doses of iodine intake with autonomous thyroid function
- common causes: contrast agent administration, amiodarone treatment
clinical picture in case of contrast agent
- TSH is very low, fT3 and fT4 are high
- iodine uptake <5%
clinical picture in case of amiodarone
- 6mg iodine from one 200mg amiodarone tablet
- inhibits 5’-monodeiodinase (catalyst of thyroid inactivation)
- direct toxic effect
What are the causes of non-thyroid thyrotoxicoses?
- diet
- psychiatric illness
- consumption of animal thyroid gland
- ovarian cyst teratoma
What are the causes of TSH-induced hyperthyroidism?
- pituitary adenoma
- T3 resistance syndrome (general or central)
What are the therapeutic options for hyperthyroidism?
- Tireostatics
- Radiojod treatment
- surgical
What are the advantages and disadvantages of tireostatics?
advantages
- easily accessible
- reversible
- cheap
disadvantages
- rarely curative
- daily treatment
- side effects
What are the advantages and disadvantages of Radiojod treatment?
advantages:
- rare side effects
- effective outside the TG
- fast effect
disadvantages:
- hospitalization (sometimes)
- irreversible efect
- expensive
What are the disadvantages of surgical intervention in hyperthyroidism?
- expensive
- surgical complications
- irreversible effect
