Endocrine Flashcards
What type of facies is this?
Myxoedematous consistent with hypothyroidism
What should be done in a thyroid exam?
Inspect
Swallow water to look for movement
Palpate from behind with neck flexed
?Tender
?Thrill
Cervical Lymph nodes
Carotids
Supraclavicular lymph nodes
Tracheal position
SCM strength
Percuss the manubrium
Auscultate for thyroid bruit and carotid bruit
Pemberton’s sign
Reflexes
Proximal myopathy
JVP
Heart sounds
Lower limbs (non-pitting oedema, or usual oedema)
Proceed for suspected hyperthyroidism:
Eyes - exopthalmos, lid lag, EOM
Hand tremor
Check specifically for AF
Proceed for hypothyroidism:
Chvostek’s and Trousseu’s signs if thyroidectomy scar is present
Hands
Tinnels or Phalens
Screening neurological upper and lower limb
Lungs for pleural effusions
Gynaecomastia
What is Chvostek’s sign?
Tap over facial nerve 3-5cm below and in front of the ear.
The facial muscles twitch briefly in the presence of hypocalcaemia.
What is Trousseau’s sign?
Pump up blood pressure cough above systolic pressure and leave it there for 2 mins. Within this time, the thumb will strongly adduct and fingers will extend in the presence of hypercalcaemia.
What are the causes for primary thyrotoxicosis?
Grave’s disease
Toxic adenoma or multinodular goitre
Hashimotos thyoiditis (early in its course)
Subacute thyroiditis
Iodine-induced (after iodine deficiency)
Excess thyroid hormone replacement
Postpartum thyroiditis
Drugs - e.g. amiodarone or lithium
What are the cause for secondary thyrotoxicosis?
Pituitary or ectopic TSH hypersecretion
Hydatidiform mole or choriocarcinoma causing high beta-HCG secretion
Struma ovarii (ectopic thyroid tumour, usually an ovarian teratoma)
Factitious
What order are the extraoccular eye muscles affected in Grave’s eye disease?
Inferior oblique
Medial rectus
Then other EOMs
Optic atrophy can occur late
What are the causes for primary hypothyroisidm without a goitre?
Idiopahtic atrophy
Treatment with iodine or surgery
Agenesis or a lingual thyroid
Unresponsiveness to TSH
What are the causes for primary hypothyroidism with a goitre?
Chronic thyroiditis (e.g. late Hashimotos disease)
Druges (lithium, amiodarone)
Endemic idoine deficiecny
What is the typical feature of reflexes in patients with hypothyroidism?
Delayed relaxation phase of ankle jerks
What cranial nerve is typically effected by hypothyroidism?
Cranial nerve 8. Often have sensuroneural deafness.
What are the causes of hypopituitarism?
Hypthalamic diseases (tumours, radiation, TB, Trauma)
Pituitary diseases:
Adenomas, cycsts
Surgery
Hypohysitis
Haemochromatosis
Infection or abscess
Infartion (sheehan syndrome)
Apoplexy (bleeding into the sella turcica)
Genetic mutations
Empty sella
In what order is hormone production lost in compressive pitutary disease (e.g. via an adenoma)
Go look for the adenoma please
Growth hormone
Lutenising hormone
Follicular stimulating hormone
Thyroid stimulating hormone
ACTH
Prolactin
Note that prolactin levels usually increase as inhibitory signals travel down the stalk to limit prolactin secretion, and stalk compression initially leads to removal of inhibitory signals of prolactin production.
What nerves are in the cavernous sinus?
III, IV, V1 and VI
What are the typical clinical findings in a patient with untreated acromegaly?
Enlarge acral bones (hands/feet/jaw/supraorbital ridge/nose)
Increased sweating in the hands
Carpal tunnel syndrome
Ulnar nerve thickening
Proximal myoapthy
Skin tags in the axillae
Greasy skin axillae
Acanthosis nigracans axillae
Macroglosia
Ance
Hirsutism
Bitemporal hemianopia (if pituitary lesion)
Fundal exam (papilloedema, angioid streaks, hypertensive or diabetic changes)
Cardiac failure
Osteoarthritis - particularly effecting the knees
Foot drop
Heal pad thickening
Hypertension
Sleep apnoea
Goitre
