What are the investigations for hypothyroidism?
- TFTs (↑ TSH, ↓T3, ↓T4)
- Thyroid antibodies
- FBC (anaemia), U&Es, LFTs
- Creatinine
- Cholesterol
- Guthrie test for congenital screening
What are 4 causes of primary hypothyroidism?
- Iodine deficiency
- Hashimotos Thyroiditis
- Post thyroidectomy → No production of T3, T4
- Drug induced → Overtreatment of hyperthyroidism
What is lid lag?
Lid lag means delay in moving the eyelid as the eye moves downwards. It is a common finding in thyroid disease when it is known as Graefe’s sign.
What are 5 symptoms of Hypothyroidism?
Think about a slowing of the metabolism:
- Weight gain
- Cold intolerance
- Constipation
- Dry skin
- Thinning of hair
- bradycardia
- Depression
- Delayed reflexes
What is graves disease?
- Autoimmune condition
- Distinguishable from other hyperthyroidism by eye signs e.g. exophthalmos and other signs e.g. pretibial myxoedema
- Associated with other autoimmune conditions e.g. pernicious anaemia
What is the surgical managment of hyperthyroidism?
subtotal thyroidectomy
What is the most common cause of hypothyroidism?
Hashimotos thyroiditis
What is the treatment or hypothyroidism?
- Conservative: patient education
* Medical: lifelong replacement of thyroid hormone with levothyroxine
What is conservative treatment for hyperthyroidism?
patient education, smoking cessation
What is the second most common cause of hyperthyroidism?
Toxic multinodular goitre
Name 4 clinical signs associated with hyperthyroidism
- Thyroid acropachy
- Onycholysis
- Exophthalmus
- Lid lag
- Pretibial myxoedema
What are 4 causes of secondary hypothyroidism?
- Dysfunction of the hypothalamic - pituitary axis
- Pituitary ademona
- Sheehan’s syndrome → Ischaemic necrosis of the pituitary gland after childbirth.
- Infiltrative disease → TB, Haemachromatosis
What are the medical treatments options for hyperthyroidism?
- Symptomatic control → Betablockers for palpitations and tremors etc.
- Antithyroid medication → Carbimazole, Propylthiouracil
- Radioactive iodine ablation
What are the investigations for Hyperthyroidism?
- TFTs (↓TSH, ↑T3, ↑T4)
- Ultrasound scan of nodules
- Fine needle aspiration of solitary nodules to exclude malignancy
- Isotope scan to assess hot and cold thyroid nodules
Name 4 complications of Hyperthyroidism?
- Atrial fibrillation
- High output cardiac failure
- Cardiomyopathy
- Osteoporosis
What is a Toxic multi-nodular goitre?
- Excess production of thyroid hormones from functionally autonomous thyroid nodules, which do not require stimulation from thyroid stimulating hormone
- Risk increase with age
- More common in females
- Single nodule suggestive of thyroid neoplasia
What is the most common cause of hyperthyroidism?
Graves disease
What are the 3 options for the treatment of Hyperthyroidism?
- Conservative
- Medical
- Surgical
What is De Quervain’s thyroiditis?
- Transient hyperthyroidism that develops after viral infection
- Goitre often painful
- Period of hypothyroidism may follow
What si the difference between primary and secondaryhypothyroidism?
- Primary is dysfunction of the thyroid
* Secondary is dysfunction of the pituitary gland
What are 4 symptoms of Hyperthyroidism? Think about speeding up the metabolism.
- Weight loss
- Warm skin/heat intolerance
- Diarrhoea
- Exopthalmus
- Lid lag
- Palpitations
- Anxiety
- Tremor
- Goitre +/- bruit
What is hashimotos thyroiditis?
- An autoimmune disease.
* It is associated with type 1 diabetes, addisons + Pernicious anaemia
What is thyroid acropachy?
- Clubbing of the fingers
- Thyroid acropachy is characterized by soft-tissue swelling of the hands and clubbing of the fingers.
- Radiographic imaging of affected extremities typically demonstrates periostitis, most commonly the metacarpal bones.
What is Onycholysis?
• The separation of a fingernail or toenail from its pink nail bed. The separation occurs gradually and is painless. Commonest cause is trauma.
