Endocrine System

Question 1

Define Hypothyroidism

Answer 1

Underactivity of thyroid

Question 2

Effects of thyroid hormone

(hint:3)

Answer 2

Increase basal metabolic rate

Regulate tissue growth and development

Maintain BP (increases adrenergic receptors in blood vessels)

Question 3

Is Hypothyroidism common endocrine disorders in UK? what are the percentages for men & women?
what are their lifetime prevalence percentage ?
What is the worldwide prevalence percentage?

Answer 3

Yes- most common endocrine disorders in UK. Common in people with down syndrome

2% in women; 9%

0.1% in men; 1%

World wide prevalence is 1-10%

Question 4

What is mean age of diagnosis?

Answer 4

60 years

Question 5

Aetiology of hypothyroidism

(hint:6)

Answer 5

1. Congenital
   - Agenism
   - Ectopic thyroid remnants
2. Defects of hormone synthesis
   - iodine deficiency
   - dyshormonogenesis
   - anti-thyroid drugs
   - other drugs
3. Autoimmune
   - atrophic thyroiditis
   - Hashimoto’s thyroiditis
   - post partum thyroiditis
4. Ineffective
   - thyroiditis
5. Post Surgery
   - Radioactive iodine therapy
   - external neck radiation
   - infiltration tumour
6. Secondary to hypothalamic pituitary disease
   - Hypopituitarism
   - peripheral resistance to thyroid hormone

Question 6

Autoimmune Hypothyroidism

Answer 6

Atrophic thyroiditis
- Anti-thyroid autoantibodies cause atrophy and fibrosis of the thyroid gland
- More common in women and the incidence increases with age

Hashimoto’s thyroiditis
- Goitre formation, firm, ‘rubbery’ gland
- More common in women in late middle age

• post partum thyroiditis
  May be misdiagnosed as postpartum depression (TFTs)

Question 7

Signs/Symptoms of hydrothyroidism

Answer 7

Signs:
Mental slowness
Psychosis
Ataxia (affect coordination, balance and speech)
Poverty of movement
Dry thin hair/loss of eyebrows
Hypertension
Hypothermia
Heart failure
Pericardial effusion
Cold peripheries
Carpal tunnel syndrome
Oedema
Periorbital oedema
Deep voice (Goitre)
Dry skin
Mild obesity
Myotonia
Muscular hypertrophy
Proximal myopathy
Anaemia

Symptoms:
Tiredness
Malaise
Weight gain
Cold intolerance
Change in appearance
Goitre
Depression
Psychosis (myxoedema madness –rare)
Coma
Poor memory
Dry, brittle hair
Coarse, dry skin
Arthralgia
Myalgia
Muscle weakness/stiffness
Poor libido
Puffy eyes
Deafness
Constipation
Anorexia

Question 8

Treatment Hypothyroidism

Answer 8

Replacement of thyroxine (Levothyroxine)

Starting dose will depend on the severity of the disease and the age/fitness of the person

Cation in older, frail people or in people with ischaemic heart disease

Question 9

Acromegaly & Gigantism

Answer 9

Acromegaly (adults)/Gigantism (children)

= excess of growth hormones

Question 10

Aetiology of Acromegaly and Gigantism

Answer 10

Always due to a GH secreting pituitary tumour

Usually occurs sporadically

Gene mutations can rarely cause familial acromegaly
- Onset before puberty leads to a higher prevalence of gigantism

Question 11

Signs/Symptoms of Acromegaly and Gigantism

Answer 11

Headaches
Visual deterioration
Deep voice
Goitre
Tiredness
weigh gain
Joint pain
Breathlessness
excessive sweating

Question 12

Management of Acromegaly and Gigantism

Answer 12

Management aims to remove the pituitary tumour by surgery or radiotherapy

Question 12

Diabetes Mellitus

Answer 12

Complex metabolic disorder characterised by chronic hyperglycemia due to relative insulin deficiency, resistance or both

Question 12

What is the global population?

Answer 12

(1 in 11 of the global population)
1 in 10 people over the age of 40

Question 13

Glucose homeostasis is principally managed by the liver through

(hint:3)

Answer 13

Glycogenesis (formation of glycogen from sugar)

Glycogenolysis (breakdown of glycogen into glucose)

Gluconeogenesis (generation of glucose from glycerol, lactate and protein)

Question 14

Type 1 Diabetes

Answer 14

A disease of insulin deficiency

5-10% of all cases of diabetes

Question 15

Aetiology of T1DM

Answer 15

Incompletely understood: involves triggering of selective autoimmune destruction of the insulin producing cells (pancreatic B cells) of a genetically predisposed individual

Increased susceptibility is inherited

The risk of developing T1DM is greater with a father with diabetes (5-7%) than with a mother with diabetes (2-5%)

If one child has T1Dm there is a 4-6% chance for each sibling

Question 16

Type 2 Diabetes

How common is this type?

Answer 16

Insulin resistance and deficiency

Most common type of diabetes accounting for 90% of all cases

Question 17

Aetiology of T2DM

Answer 17

Genetic susceptibility
Ageing
Fetal origins of diabetes
Low birth weight also predisposes to other chronic diseases
Obesity
Physical inactivity
Urbanisation
Poverty
Abnormal sleep patterns
Environmental toxins
Mental illness

Question 18

Self management is the best route of care

Answer 18

Self management education
Diet
Physical activity
Smoking
Insulin