Thyroid #tipsfornewdoctors – sick euthyroidism

The number of TFTs checked in hospital has ⬆️⬆️⬆️ in recent years.

We are always looking for easily reversible thyroid problems as the cause for symptoms, but how often do we find this?
In one study, ~15% of inpatients have mildly abnormal TSH but only 1-2% a true underlying thyroid abnormality.

+ many with abnormal TFTs have no follow up of this anyway!
Acutely unwell patients often have abnormal TFTs – said to be a metabolic compensation.

We called this “sick euthyroid syndrome” or “non-thyroidal illness” (NTI).

This is seen with lots of serious illnesses e.g. sepsis, and also with starvation.
The key feature of NTI = ⬇️⬇️ in T3 (active thyroid hormone)
(this is actually metabolised to “reverse T3” -we don’t measure this)

T4 and TSH can be ➡️ or ⬇️ in NTI
A fall in T4 indicates more severe illness

See image below from Medscape:
So in severe cases with low/N TSH, low T4 and low T3 – this looks like central (secondary) hypothyroidism

As the person recovers, TSH rises to restore normality again
We don’t know if NTI should be treated or not (like a secondary hypothyroidism), so currently this is NOT routine.

It is good practice to ensure patients have their TFTs checked again when they recover (typically at 6 weeks) to ensure there is no underlying abnormality

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More from @BukuEndo

26 Jan
Ok #MedStudentTwitter so we've got the basics of endocrinology now.

Keep reading for how that helps us understand hormone test results ⬇️⬇️
When faced with endocrine results, we usually start with the EFFECTOR HORMONE – is this normal/abnormal? ✅❎

If abnormal, we then look to the 2ry controlling hormone – has this made an APPROPRIATE COMPENSATION?
This is 🔑 with endocrinology - an "appropriate compensation" often puts the 2ry hormone out of the "normal" reference range.

This is what should happen if the control centre is working properly!

So is it "appropriate" NOT is it "normal" is the Q we ask!
Read 5 tweets
26 Jan
Hormones are tightly regulated🔄

For most we use a “neuroendocrine” system:

- a control centre in 🧠 (hypothalamus & pituitary) which integrate feedback & send signals (⬇️⬆️) to the

- primary endocrine glands (e.g. thyroid) re. how much “effector hormone” to make
"Tropic" hormones (e.g. corticotropin aka ACTH) signal to another endo gland.

"Effector" hormones have widespread targets throughout the body & usually affect processes e.g. growth, metabolism 👶👧👩‍🦰
They also ‘feed back’ on the control centre 🔄
Tropic hormones include ACTH, TSH, FSH, LH and GH (anterior pituitary) 🧠.

Their respective effector hormones are cortisol, thyroid hormones (T3/T4), oestradiol/testosterone & IGF-1.
Read 5 tweets
26 Jan
This week we are going to cover some #Endocrinology topics for #medstudenttwitter.

Going to start with some fundamentals to get us going as grasping these basics really makes interpretation much easier!
Endocrinology is about communication! 📞📢

Hormones are messengers that travel around the body to act in distant organs and tissues.

There are 2 main types of hormones. Knowing a little about this helps predict hormone behaviour:
STEROIDS🔶 – cortisol, aldosterone, sex hormones. Vit d and thyroid hormones are included in this group as they behave similarly.

Water insoluble - circulate on binding proteins, have long t1/2

Diffuse across lipid membrane to act via NUCLEAR receptors ➡️ SLOW effect on genes
Read 4 tweets
4 Jan
So this weekend you heard from our friends @BukuRenal that mismanagement of IV fluids can cause harm.

A group we’d like to highlight who can come to serious harm from ⬆️/⬇️ fluids is patients with

💦DIABETES INSIPIDUS 💦

See below 👇

#medtwitter #FOAMed
Diabetes insipidus (DI) is the inability to hold onto water due to lack of /resistance to ADH.

Remember ADH is released as serum osmolality ⬆️ to ⬆️ renal water reabsorption, but in patients with DI this doesn’t occur and so they pass large vol watery urine - can be >10L/day!🛁
Note diabetes insipidus has nothing to do with glucose/sugar like diabetes mellitus! ⛔️❌⛔️

Misunderstandings are so common (even with HCPs) that there is a campaign to change the name to "pituitary insipidus"

#NoTimeToDI
Read 12 tweets

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