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Thyroid Disorders (Hypothyroidism (Symptoms (Cold intolerance, Low mood,…
Thyroid Disorders
Hypothyroidism
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Aetiology
Drug induced e.g. amiodarone, lithium
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Primary atrophic hypothyroidism - autoimmune, lymphocytes infiltrate thyroid causing atrophy
Hashimoto's Thyroiditis - autoimmune, antithyroid autoantibodies are formed - most common cause in UK
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Risk Factors
Autoimmune hypothyroidism is associated with other autoimmune disease e.g. diabetes, Addison's, pernicious anaemia
Hypothyroidism is associated with Turner's syndrome, Down's syndrome, cystic fibrosis, primary biliary cirrhosis
Pathophysiology
Underactivity of the thyroid is usually primary from disease of the thyroid but can also be secondary due to hypothalamic-pituitary disease, resulting in reduced TSH drive
Myxoedema coma: Severe hypothyroidism that presents with coma, confusion, hypothermia, cardiac failure, hypoglycaemia before death. Must give IV T3, glucose infusion and rewarm patient
Signs
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Bradycardia
Reflexes relax slowly
Ataxia (lack of voluntary coordination of muscle movement)
Dry thin hair/skin
Yawning
Cold Hands
Ascites
Round puffy face
Defeated demeanour
Immobile
Congestive heart failure
Diagnosis
Thyroid function tests
Primary hypothyroidism: Low T3/T4, high TSH
Secondary hypothyroidism: Low T3/T4, low TSH
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Hyperthyroidism
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Investigations
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Thyroid function tests
Primary hyperthyroidism will show: High T3/T4, low TSH
Secondary hyperthyroidism (problem with pituitary) will show: High T3/T4, high TSH (as negative feedback loop does not work)
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Thyroid Storm
Signs: tachycardia, delirium, coma, hyperpyrexia, death
Precipitated by stress, infection, surgery
Life threatening condition where there is a rapid deterioration of thyrotoxicosis (rapid T4 increase)
Treat with large doses of oral carbimazole, oral propranolol, oral potassium iodide (to acutely block the release of thyroid hormone), IV hydrocortisone (to inhibit peripheral conversion of T4 to T3)
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Thyroid Carcinoma
Epidemiology
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Not common, approx 400 deaths annually in UK
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Types
Follicular: 20%, spreads to lung + bone, good prognosis, arise from thyroid epithelium
Anaplastic: <5%, poorly differentiated, aggressive, poor prognosis, arise from thyroid eptihelium
Papillary: Most common (70%), well differentiated, local spread, good prognosis, arise from thyroid epithelium
Clinical Presentation
Enlarged, hard and irregular thyroid gland is indicitive of a carcinoma
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