Thyrotoxicosis

Front 1

Thyrotoxicosis: Clinical Presentation, Investigations, Hormone Abnormalities, Differential Diagnosis

Back 1

1. Clinical Presentation: hyper but tired, difficulty concentrating, family Hx of autoimmune disease, hyper-reflexia, proximal muscle weakness, restlessness, rapid speech, weight loss, increased appetite, tachycardia, sweating, warm soft skin, exopthalmos, diploplia, goiter, tremor
2. Investigations: initially do sTSH, free T4, free T3, serum K+, ECG, betaHCG, CBC, if thyrotoxic then do radioactive iodine uptake(RAI) and thyroid stimulating immunoglobulin(TSI) tests
4. Hormone Abnormalities: high T3/T4+low TSH (primary), high T3/T4+high TSH(secondary)
5.Differential Diagnosis: high RAI uptake disease (Graves', multinodular goiter, toxic adenoma), low RAI uptake disease (subacute thyroiditis, exogenous thyroid hormone)

Front 2

What is the differential diagnosis for feeling "hyper but tired"? (10)

Back 2

anxiety, caffeine excess, drugs, drug withdrawal, hyperthyroidism, anemia, eating disorder, arrhythmia, pheochromocytoma, hypoglycemia

Front 3

Thyroid Stimulating Immunoglobulin: Target, Effects, Correlation to Disease

Back 3

1. Target: TSH receptor
2. Effects: goiter (stimulation of growth), hyperthyroidism (increased T3/T4 production), hypothyroidism (blocking T3/T4 production), orbitopathy (interacts with fibroblast receptors behind eye)
3. Correlation to Disease: correlates with disease activity

Front 4

Graves' Disease: Pathophysiology, Treatment

Back 4

1. Pathophysiology: autoimmune production of Thyroid Stimulating Immunoglobulins against TSH receptor
2. Treatment: Beta-blocker (symptoms), Thiouracil (first line), radioactive iodine (second line), surgery (third line)

Front 5

Pathophysiology of Thyrotoxic Diseases: Multinodular Goitre, Toxic Adenoma

Back 5

1. Multinodular Goitre: multiple benign nodules that make excess hormone, if cold could be cancerous
2. Toxic Adenoma: benign tumour that makes hormone independent of TSH