Other thyroid conditions Flashcards
(9 cards)
What is acute suppurative thyroiditis?
- Inflammation due to bacterial infection
- Presents with fever, swelling and tenderness of the thyroid gland, lymphadenopathy and erythema (redness) of the skin over the gland.
- Associated with leucocytosis (raised WBC) but thyroid hormone levels are usually within the reference ranges
- Acute suppurative thyroiditis requires antibiotic therapy to prevent abscess formation, and possible surgery to drain any abscess that has already formed.
Other causes of thyroiditis which cause hypo- or hyperthyroid include:
* Chronic autoimmune thyroiditis
* Subacute thyroiditis
* Post-partum thyroiditis (discussed previously)
What goes wrong with the parathyroid gland - what is hypoparathyroidism?
- Parathyroid gland is associated with calcium levels in the blood
- Hypoparathyroidism is associated with parathyroid hormone (PTH) deficiency, which results in
- Serum calcium deficiency (due to reduced osteoclastic activity
- reduced vitamin D activation, and
- increased urinary calcium excretion)
What causes hypoparathyroidism?
- Genetic/congenital
- Autoimmune - immune system attacking parathyroid glands
- Iatrogenic (following radiotherapy or surgical parathyroidectomy or thyroidectomy for hyperparathyroidism or hyperthyroidism).
- Infiltration of the parathyroid glands by metals (iron, copper, aluminium)
- Infiltration of the parathyroid glands - systemic sclerosis or metastatic disease.
- Magnesium deficiency causes reversible hypoparathyroidism
What are the signs and symptoms of hypoparathyoidism?
Generally related to calcium deficiency - which reglates nervous system function and muscle contraction
* Peripheral paraesthesia - abnormal sensations
* Muscle cramps (lower back, legs, and feet).
* Positive Chvostek and Trousseau signs
* Laryngospasm, bronchospasm
* Possible seizures
* Ataxia, dysphagia - muscle and nerve function
* Anxiety, depression, fatigue, confusion
* Chronic hypocalcaemia, is associated with ocular cataracts, abnormal dentition, and dry, puffy, coarse skin.
What are common tests and investigations, and treatments, for hypoparathyroidism?
Blood tests
* Low PTH (parathyroid hormone)
* Low serum calcium
* High phosphorus
* Possible ECG abnormalities due to the affect of altered serum calcium levels on cardiac function
Treatment involves correcting low blood calcium levels (hypocalcemia) by
administering calcium and vitamin D.
In some cases recombinant human PTH may also be prescribed.
What is hyperparathyriodism?
- Hyperparathyroidism where one or more of the parathyroid glands become overactive
- It is associated with excessive secretion of parathyroid hormone, which results in elevated levels of plasma calcium due to:
- Increased calcium release from bone matrix,
- Increased calcium reabsorption by the kidneys
- increased renal production of 1,25-dihydroxyvitamin D-3 (calcitriol), which increases intestinal absorption of calcium
Together lead to high levels of blood calcium
What causes hyperparathyoidism?
- Primary hyperparathyroidism may be due to genetic parathyroid hyperplasia, or a adenoma / carcinoma.
- Secondary hyperparathyroidism is the overproduction of parathyroid hormone (PTH) secondary to hypocalcemia, typically as a result of vitamin D deficiency and/or chronic kidney disease (CKD). In this case the low levels of calcium in the blood trigger released levels of PTH
What are the signs and symptoms of hyperparathyoidism?
- Polyuria - frequent urination as body tries to excrete more calcium
- Kidney stones
- GI symptoms (pain, anorexia, nausea, vomiting, constipation)
- Fatigue
- Muscle weakness
- Depression
- Poor memory & concentration
- Confusion
- Hypertension
- Bradycardia
- ECG abnormalities
- Elevated PTH
- Elevated serum calcium
- Osteopenia - or osteoporosis - reduced bone density
How do you treat hyperparathyroidism?
Treatment consists of surgical removal of one or more parathyroid glands
We usually have 4 parathyroid glands
