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Thryoid - Coggle Diagram

- - - - Prodrome of viral illness
        Sore neck
        Thyrotoxic
        Do not give anti-thyroid meds - depletes thyroid hormone and causes hypothyroidism
  - - - Lid lag
        Lid retraction
        Proptosis
  - - - Female
    - - Smoking
  - - - Weight loss
        
        Palpatations
        
        Dyspnoea
        
        Tiredness, fatigue, weakness
        
        Tremor
        
        Anxiety
        
        Mentrual disturbance
        
        Eye symptoms
    - - Tachycardia
        
        Atrial fibrillation
        
        Systolic HTN
        
        Cardiac failure
        
        Fine tremor
        
        Warm skin & hair loss
        
        Musle weakness - proximal myopathy
        
        Goitre
    - - Opthalmopathy
        
        Eyelid lag, retraction
        
        Double vision
        
        Periorbital oedema
        
        Optic neuritis
        
        Dermopathy
        Acropathy
  - - - TSH
        Free T4 / T3
        TSH receptor antibodied TRAb
    - - Radioactive iodine
      - Technetium 99
        
        Diffues uptake - Butterfly
  - - - Symptom Control
        
        Beta blockers
        
        S/e
        Sleep distrubance
        Sexual disturbance
      - Disease modifing
        
        Propylthiouracil
        
        Carbimazole
    - - Thryoidectomy
      - Indications
        
        Drug intolerance
        Large goitre / compression symptoms
        Severe opthalmopathy + drug intolerance
        Immediate future pregnancy
    - - Minor
        
        Rash / Pruritis
        
        5% transient selt limiting
        Antihistamines
        BBZ > PTU
        Dose-dependent
        Change to alternate drug
        
        Hair-loss 4%
        
        Possibly realted to hypothyroidism
        Possibly CBZ
        
        Abnormal taste / smell
        
        CBZ only
        
        Nausea
        
        Diarrheoa
        
        Arthralgia
        
        1-5%
        Esp in high doses of CBZ
      - Major
        
        Arthritis
        
        Migratory
        Dose dependent
        
        Vasculitis
        
        PTU>> CBZ
        FEver, LN, Splenomegaly, nephritis, anti-DNA ab
        Nephritis, polyarteritis, ANCE +vs
        
        Hypothrombinaemia
        
        PTU
        
        Insulin Ab
        
        Hypoglycaemia
        PTU
        
        Hepatic
        
        Abnormal LFTs up to 35% of thyrotoxic pts
        
        PTU
        Hepatitic picture
        If rx causes risk in 30% then stop
        RUQ, jaundice, malaise - stop
        Can be fatal
        
        CBZ
        Cholestasis or mixed picture
        Reversible not life threatening
        
        Agranulocytosis
        
        0.1-0.5%reported
        Mean time onset 30-40 days most within 3 months
        Risk possibly higher in elderly ad possibly female
        Elderly more likely to die
        Can occur on rechallenge
        Any ATD Contraindicated
        Use of GCSF cibtriversial - retorspective studies suggest benefit (LOS, duration of Low WCC) but prospective study showed no benefit
        Recen GWAS study suggests HLA association
        Risk CBZ = PTU
    - - Radioactive Iodine Therapy
        
        Definitive
        Pt euthyroid on rx or B-blockade
        
        Risks
        
        Hypothyroidism
        Carcinogen
        Teratogenesis pregnancy avoidance
        Contact issues
        
        C/I
        
        Pregnancy / Lactation
        Modeate to severe thryoid eye disease
        
        Steroid prophylaxis for active mild thyroid eye disease
        
        {rednisolone 30mg 1week before - tail at 5mg / wk
        
        Debatable for inactive or no TED
  - - - Painful eyes
        
        Pain on eye movement
        
        Double vision
        
        Reduction in VA
        
        Changes in appearance
    - - Proptosis
        
        Lid retraction
        
        Eyelid erythema
        
        Eyelid Oedema
        
        Chemosis
        
        Eye movements
- - - - U0-5
      - Allows for stratifying thyroid nodules as benign, sus, or malignant
      - Streamlines further investigation
    - - Thy 1-5
- - - - 1.6-1.μg/kg body weight
        TFTs equilibrate in 6-8 weeks
        Wellbeing changes in 3-4 mmonths
        Caution in cardiac disease / angina
        Increased requirement in pregrancy
      - Interfernce in Absorption
        
        Coeliac
        
        Cholestyramine
        
        Aluminium hydroxide, calcium carbonate
        
        FErrous sulphate, sucralfate, soybean, fibre
        
        Espresso coffee- PPIs, hypochlorhydria
      - Increased Metabolism
        
        Phenytoin
        
        Rifampicin
        
        Phenobarbitone
        
        Carbamazepine
- - - - 1-4% of the poulation
    - - Discordant ociture
- - - - Graves
      - Thyroid nodules with autonomous function
      - Rarer causes:
        Resistance to thyroid hormone
        TSHoma
    - - Thyroid inflammation eg thyroiditis
      - Exogenous thyroid hormone
      - Rarer causes: Struma Ovarii