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Endocrine condiitons - Coggle Diagram

- - - - autoimmune disease where antibodies stimulate TSH receptor --> hyperplasia of thyroid follicular cells --> smooth diffuse goitre
      - characteristic eye changes eg exophthalmos and pretibial myxedema (thtroid dermopathy)
      - specific antibody test: anti-TSH receptor antibodies :star:
    - - normally has history of viral fever, UTI, etc
      - 4 phases: hyper - eu - hypo - eu but most px remain in a transient hypo period
      - treated using NSAIDs or b-blockers
  - - - normal T4
        
        measure T3
        
        if normal, its resolving hyperthyroidism or subclinical hyperthyroidism or pregnancy or drugs (amiodarone)
        
        if high = T3 thyrotoxicosis
      - high T4
        
        indicates 1ary hyperthyroidism, so do radioactive uptake
        
        if low, measure thyroglobulin (tumour marker and T3/4 precursor
        
        if decreased, its due to an exogenous source eg iodine pills
        
        if increased, it indicates subacute thyroiditis or iodine exposure or extraglandular production
        
        if high and diffuse, indicates Grave's disease
        
        if high and nodular
        
        in multiple areas = toxic multinodular goitre
        
        US if palpable thyroid nodule
        
        in one area = toxic adenoma
    - - measure T4
        
        if high, its 2dary hyperthyroidism so do MRI of pituitary gland
  - - - antithyroid drugs if likely to achieve remission and surgery/iodine unsuitable
        
        radioactive iodine 1st line :star: unless antithyroid drugs are likely to reach remission or iodine is unsuitable (pregnancy, malignancy, thyroid eye disease)
        
        surgery (total thyroidectomy for graves or hemithyroidectomy for TNG) 1st line if concerns about compression, malignancy suspected, iodine/antithyroid drugs are unsuitable
    - - Carbimazole 12-18 months - titration regimen
      - proprylthiouracil if adverse reactions to carbimazole, pregnancy or trying in 6 months, hx of pancreatitis
      - STOP if person develops agranulocytosis :star:
    - - TSH, T3, T4 if on iodine, every 6 weeks for first 6 months until TSH is normal
      - if develops hypothyroidism, give levothyroxine
      - offer levothyroxine after surgery and measure TSH and T4 after 2, 6, 12 months
      - if on antithyroid drugs, measure TSH, T4 and T3 every 6months until TSH is normal, then only TSH every 3months after drugs are stopped
- - - - autoimmune eg Hashimoto's
        
        destruction of thyroid cells by cell/antibody-mediated immune processes
        
        may present with smooth diffuse goitre --> later thyroid atrophy and myxoedema
      - radio-iodine treatment/surgery/radiotherapy due to eg lymphoma
      - iodine deficiency**
      - drugs eg amiodarone, lithium, contrast
      - infiltration due to amyloidosis, sarcoidosis etc
    - - pituitary dysfunction eg tumour, surgery, infection
      - hypothalamic dysfunction eg tumours, trauma
    - - postpartum thyroiditis - 4 stage cycle but some women remain in hypo
      - subacute/de Quervain thyroiditis with transient hypo
  - - - if above reference range, measure T4
      - if below reference range, measure T3 and T4
  - - - 1.6mcg/kg/day if <65 and no hx of CVS disease
      - 25-50mcg/day if >64 or hx of CVS disease
      - if subclinical, TSH should be >10mlU/L on 2 separate occasions 3 months apart
    - - measure TSH every 3 months until consistently normal, then every year
  - - - high TSH and low T4
    - - high TSH BUT normal T4