Thread by @Anneesa_M, CALLING ALL MEDICAL STUDENTS Endocrinology can be hard. Here’s my first #tweetorial [...]

Anneesa

Anneesa_M

CALLING ALL MEDICAL STUDENTS

Endocrinology can be hard.

Here’s my first #tweetorial with @MedicsAcademy about Graves’ disease to make it a bit easier...

#MedTwitter #sdocs #medicalstudent #gravesdisease #thyroid #endocrine #preclinical @MedTweetorials

1/13

Key Learning Outcomes:

What is Graves’ disease

Symptoms of hyperthyroidism

Understanding the hypothalamic-pituitary-thyroid axis

Thyroid eye disease (exophthalmos)

Treatment options

2/13

J is a 35 y/o female diagnosed with Graves’ disease.

Her GP explains to her:

It’s a common cause of hyperthyroidism

Graves is an autoimmune disease

3/13

Her blood test shows:

TSH

T4

Which blood test result would most likely be consistent with J’s Graves diagnosis?

4/13

IgG antibodies bind to TSH (thyroid stimulating hormone) receptors in the thyroid, stimulating the release of thyroid hormone.

The HYPOTHALAMUS secretes TRH (thyrotropin releasing hormone) which acts on the ANTERIOR PITUITARY to release TSH.

Continued...

5/13

IgG antibodies stimulating the thyroid increases release of T3/4 which activates the negative feedback mechanism.

T3/4:
- Inhibits the pituitary gland releasing TSH
- Inhibits the hypothalamus from releasing TRH, preventing pit gland release of TSH

Hence, J has

TSH

6/13

IgG antibodies stimulating the thyroid increases release of T3/4 which activates the negative feedback mechanism. T3/4:- Inhibits the pituitary gland releasing TSH - Inhibits the hypothalamus from releasing TRH, preventing pit gland release of TSHHence, J has TSH6/13

J presents with the symptoms of hyperthyroidism:

Exophthalmos

Weight loss

Warm skin

Anxiety

Tremor

7/13

J asks why Graves causes her eyes to bulge.

What does her GP reply?

8/13

Retroorbital inflammation results in focal oedema of extra orbital muscles

Swollen orbital tissues pushes the eyeball forward & can impede venous return, increasing pressure on the optic nerve leading to optic atrophy

9/13

A biopsy of her thyroid below shows:

Colloid scalloping (S) due to increased use of colloid to produce more thyroid hormone

Increased follicular cells bunching into papillae (P)

10/13

A biopsy of her thyroid below shows: Colloid scalloping (S) due to increased use of colloid to produce more thyroid hormone Increased follicular cells bunching into papillae (P) 10/13

If J is not treated, she could develop the following as a result of the persistent systemic effects of elevated thyroid hormone...

Atrial fibrillation

Cardiomyopathy

Osteoporosis

High output heart failure

11/13

If J is not treated, she could develop the following as a result of the persistent systemic effects of elevated thyroid hormone...Atrial fibrillation Cardiomyopathy Osteoporosis High output heart failure 11/13

Her GP considers her treatment options based on the NICE guidelines.

Her GP:
- Educates her on Graves
- Prescribes the anti-thyroid drug, carbimazole