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Questions and Answers
What is the primary goal of using antithyroid medications in treating Graves' disease?
What is the primary goal of using antithyroid medications in treating Graves' disease?
What is a rare but dangerous worsening of the thyrotoxic state that can lead to death within 48 hours if left untreated?
What is a rare but dangerous worsening of the thyrotoxic state that can lead to death within 48 hours if left untreated?
What is a potential complication of thyroidectomy, a surgical treatment for Graves' disease?
What is a potential complication of thyroidectomy, a surgical treatment for Graves' disease?
What is a common side effect of antithyroid medications that requires monitoring?
What is a common side effect of antithyroid medications that requires monitoring?
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What is a primary cause of hypothyroidism?
What is a primary cause of hypothyroidism?
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What is a clinical manifestation of hypothyroidism?
What is a clinical manifestation of hypothyroidism?
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What is a rare but potential complication of radioactive iodine therapy or surgery for Graves' disease?
What is a rare but potential complication of radioactive iodine therapy or surgery for Graves' disease?
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What is a symptom of thyrotoxic crisis?
What is a symptom of thyrotoxic crisis?
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What is a potential consequence of undiagnosed or partially treated Graves' disease?
What is a potential consequence of undiagnosed or partially treated Graves' disease?
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What is a potential treatment for severe ocular changes in Graves' disease?
What is a potential treatment for severe ocular changes in Graves' disease?
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Study Notes
Type 2 Diabetes Mellitus
- Diagnosis requires two abnormal test results demonstrating hyperglycaemia or one abnormal result with symptoms of hyperglycaemia.
- Fasting venous blood glucose levels ≥ 7.0 mmol/L or random venous blood glucose levels ≥ 11.1 mmol/L indicate diabetes.
- A plasma fasting blood glucose level < 6.1 mmol/L suggests diabetes is unlikely.
Oral Glucose Tolerance Test
- Requires overnight fasting followed by consumption of a glucose drink containing 75g of glucose.
- Blood glucose levels are monitored after fasting and 2 hours after glucose ingestion.
- In individuals without diabetes, blood glucose levels will rise and then decrease to < 7.8 mmol/L after 2 hours.
- In individuals with diabetes, fasting blood glucose levels are raised, and levels remain > 11.1 mmol/L after 2 hours.
Pre-Diabetes
- A condition in which glucose homeostasis is between normal and diabetic levels.
- Impaired fasting glucose: fasting blood glucose level is raised, but the response to the oral glucose tolerance test appears normal.
- Impaired glucose tolerance: fasting blood glucose level is normal, but there is a hyperglycaemic response to the oral glucose tolerance test, but to a lesser extent than seen with diabetes.
Pathophysiology
- Insulin deficiency: a shortage of insulin.
- Insulin resistance: ineffective response to insulin at target cells.
- Obesity: insulin is less able to facilitate the entry of glucose into the liver, skeletal muscles, and adipose tissue.
Monitoring Blood Glucose Control
- Glucometer: allows patients to monitor the effectiveness of their lifestyle measures and diabetes medications.
- HbA1c: measures glycated haemoglobin, indicating average blood glucose levels over recent weeks.
Complications
- Acute complications: hypoglycaemia, diabetic ketoacidosis, and hyperglycaemic hyperosmolar state.
- Chronic complications: neuropathy, nephropathy, retinopathy, and cardiovascular disease.
Hypoglycaemic Shock
- Excess insulin leads to hypoglycaemia, which can cause severe activation of sympathetic nervous system responses.
- Hypoglycaemia can lead to severe neuronal dysfunction, coma, and death if not treated promptly.
Diabetic Ketoacidosis
- The inability of glucose to enter cells leads to the use of lipids as cell fuel, resulting in the formation of ketone bodies.
- Ketone bodies can lead to ketoacidosis, which can cause dehydration, polyuria, and glycosuria.
Hyperglycaemic Hyperosmolar State
- A rare but significant complication of type 2 diabetes with a high mortality rate (approximately 15%).
- Characterized by hyperglycaemia, dehydration, and electrolyte imbalance.
- Treatment requires aggressive fluid and electrolyte resuscitation and strict control of serum glucose levels.
Thyroid Dysfunction
- Hyperthyroidism: a condition where thyroid hormone levels are higher than normal.
- Thyrotoxicosis: a hypermetabolic state caused by high thyroid hormone levels.
- Symptoms of thyrotoxicosis include tachycardia, palpitations, nervousness, insomnia, heat tolerance, moist skin, tremor, and increased systolic blood pressure.
Graves' Disease
- An autoimmune condition and the most common cause of hyperthyroidism.
- Characterized by immune stimulation of thyroid cells, leading to gland enlargement and vascularity.
- Symptoms include exophthalmos (protrusion of the eyeball), periorbital oedema, and extraocular muscle weakness leading to diplopia (double vision).
Clinical Manifestations of Thyroid Dysfunction
- All signs and symptoms of thyrotoxicosis.
- Additional symptoms in Graves' disease include ocular changes, immunological stimulation, and enlargement of the ocular muscles.
Diagnosis of Thyroid Dysfunction
- Measurement of thyroid hormone levels (free thyroxine and free triiodothyronine).
- In primary hyperthyroidism, thyroid hormone levels are raised, and TSH levels are decreased.
Treatment of Thyroid Dysfunction
- Achieve symptom control and reduce thyroid hormone levels where possible.
- Antithyroid medication (carbimazole and propylthiouracil) is commonly used as first-line therapy.
- Radioactive iodine therapy or surgery may be required in some cases.
- Thyroidectomy carries a small risk of permanent hypoparathyroidism and recurrent laryngeal nerve damage.
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Description
Learn about the diagnostic criteria for Type 2 Diabetes Mellitus, including the required blood glucose levels and symptoms. Test your knowledge of diabetes diagnosis!
