Endocrinology Flashcards
(39 cards)
Auscultation of thyroid gland. Hear a sound, what are the differentials?
Thyroid bruits
Carotid bruits (loudest over carotids
Radiation of cardiac murmur ie AS
Venous hum (opliterated by slight pressure)
What condition causes thyroid bruits?
Graves thyroiditis (most common)
Other forms of thyroiditis
What are the signs of thorasic outlet obstruction on pembertons sign?
Plethora (redness in cheeks)
Cyanosis of the lips or tongue
Resp distress or emergence of stridor
Neck vein dilation
General inspection findings in hyperthyroidism?
Frightened facies (not just with graves disease)
Low BMI
Minimal clothes / a fan (ie heat intolerance)
Obvious tremour
Nail findings in hyperthyroidism?
Onycholysis - from sympathetic overactivity
Thyroid acropachy (clubbing) - only seen in graves disease not other form of hyperT
Reflexes in hyper vs hypothyroidism?
Brisk in hyper, hung up or myotonic in hypo
Is proximal myopathy present in hyper or hypothyroidism?
Both
Components of thyroid eye disease? Components of graves eye disease specifically?
Thyroid eye disease genrally:
- Thyroid stare
- Lid retration (can see sclera above iris)
- Lid lag (test on vertical gaze)
Graves eye disease:
- Exopthalmos (examine from side and above to see eye protruding)
- Chemosis, conjuntivitis, conrneal ulceration
- Optic atrophy
- Opthalmoplegias
Ptosis present in thyroid patient. WHat could be the differential?
MG
- Can be associated with autoimmune thyroid disease
What is pretibial myopdema and which condition does it appear in?
bilateral firm elevated dermal nodules and plaques which can be pink brown or skin coloured (only occurs in Graves disease)
Chest and heart findings in hyperthyroidism?
Gynacomastia (in males)
Flow murmurs
Exacerbation of congestive cardiac failure
What are the differentials for hypertyroidism?
Primary hyperthyroidism:
Autoimmune thyroid disease
- Graves disease
- Early stage of Hashimotos thyroiditis
Drugs:
- Amiodarone (type 1 and 2), immune checkpoint inhibitors (pembrolizumab, nivolumab), lithium
- Factitious (ingestion of levothyroxine)
Infection:
- Superative thyroiditis
- Subacute thyroiditis (viral thyroiditis)
Vascular
- Thyroid ischemia
Neoplastic:
- Toxic adenoma
- Toxic multinodular goiter
Secondary hyperthyroidism
- pituitary causes of increased TSH
General inspection signs of hypothyroidism?
Increased BMI
Lots of cloths (cold intolerance)
Slow deep nasal speech
Obvious mental and physical slowing
Hand findings in hypoT?
Cool dry peripheries
Peripheral cyanosis sue to reduced CO
Palmar palor
Yellow discolouration (hypercarotinaemia)
Face findings in hypoT?
SKin but not sclera appear yellow (hypercarotinaemia)
Skin may be puffy and dry appearing, and thickened
Alopecia with loss of outer third of eyebrow and vitligio
Eyes:
- Xantholasmata
Tongue:
- Macroglossia / tongue swelling
Acromegally spot disagnosis (general insepction and signs)?
Wide spade like hands often with gaps between fingers
Frontal bossing
THickened lips
Big nose
Large jaw with spacing between teeth
If see this then think ? acromegally
Signs of disease activity acromegally?
Number of skin tags (specifically whether they are increasing)
Hypertension
Warmth and excessive sweatiness
enlarging Goiter
Visual field defects
Glycosiuria
Investigations for hyperthyroidism?
TFTs
- Supressed TSH (Primary)
- Elevated TSH (secondary)
- Elevated fT3,4
Thyroid autoantibodies:
- TSH receptor Abs - activating (Graves disease) or inhibbitory (hashimotos)
- TPO (most common ab overall, classic in hashimotos)
- Thyroglubulin ab - Usually present with anti-TPO abs
Ultrasound:
- Nodularity, vascularity. Used to guide FNA and Bx
Radioactive Iodine uptake (scintigraphy)
- Nodular uptake (MNG), single hot uptake (toxic adenoma), diffuse (graves disease)
- No uptake (post partum, painless/subacuite thyroiditis)
Biopsy:
- Exclude cancer
Investigations for hypothyroidism?
TFTs
- Low fT3,4
- Elevated TSH >10 (primary)
- Low TSH (secondary)
- Tertiary (Low TRH) - this is rare
Thyroid autoantibodies:
- Anti-TPO, anti-Tg in hashimotos
- Nil antibodies in other conditions
Ultrasound:
- Nodularity, vascularity. Used to guide FNA and Bx
Radioactive Iodine uptake (scintigraphy)
- No uptake (post partum, painless/subacuite thyroiditis)
ECG
- SInus brady, low voltages, T wave inversion
Investigations for acromegally?
Diagnosis:
- Serum IGF-1 (high sensativity). Dont use GH given flutuations
- Glucose supression test (Similar to OGTT)
-> GH >1ng/ml 2 hrs post 75g OGTT confirms Dx (GH should be supressed by OGTT therefore if it is not suppressed this suggests acromegally)
- TRH stimulation test (alternative to above OGTT)
- MRI pituitary
Explain TIRADS system for thyroid nodules?
THis is a scoring system to identify teh risk of a thyroid nodule being cancer based on sonographic features:
The five ultrasound features of thyroid nodules used in TI-RADS are: composition, echogenicity, shape, margin and punctate echogenic foci. Each item is given points which then add to a score that determines risk and therefore guides further Ix and follow up.
The points are added from all categories to determine the TI-RADS level, each with a recommendation
Explain types of amiodarone induced thyroiditis?
There are two types of amiodarine induced thyroiditis:
- Type 1 (iodine-induced)
- Type 2 (destructive thyroiditis)
What is the Jod-basedow and the wolff-chaikoff effect?
Jod-Basedow
- Hyperthyroidism following an iodine load
- Typically affects pts with iodine def goiter when they move to place with adequate iodine intake -> hyperthyroidism. Also affects pts with graves and MNG/toxic adenoma following iodine load (ie amiodarone, iodinated contrast)
Wolf-Chaikoff efects is when thyroid hormone is supressed following iodine load (this is the effects in normal pts who have an iodine load)
What are complications of acromegally?
Cardiovascular:
- Lipids
- HTN
- CCF
- Arrhythmias
Endo:
- DM
- OP (vertebral fractures)
- Hypogonadism
Resp:
- OSA
Neuro:
- visual changes
- Carpel tunnel syndrome
Other:
- SKin changes (asrthetic)
- Bowel cancer
