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3: MED2 Y3 - Endocrinology [5] > [17] Thyrotoxicosis > Flashcards

[17] Thyrotoxicosis Flashcards

1
Q

What is thyrotoxicosis?

A

The clinical effect of increased T4, usually from gland dysfunction

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2
Q

What are the symptoms of thyrotoxicosis?

A 
Diarrhoea
↑ appetite but ↓ wt.
Sweats, heat intolerance
Palpitations
Tremor
Irritability
Oligomenorrhoea ± infertility
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3
Q

What are the hand signs of thyrotoxicosis?

A

Fast/irregular pulse
Warm, moist skin
Fine tremor
Palmar erythema

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4
Q

What are the face signs of thyrotoxicosis?

A

Thin hair
Lid lag
Lid retraction

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5
Q

What are the neck signs of thyrotoxicosis?

A

Goitre or nodules

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6
Q

What are the graves specific signs of thyrotoxicosis?

A

Opthalmopathy
Dermaopathy
Thyroid acropachy

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7
Q

What are the opthamology signs of Graves?

A 
Exopthalmos 
Opthalmoplegia, especially up-gaze palsy
Eye discomfort and grittiness
Photophobia and decreased acuity
Chemosis
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8
Q

What are the dermopathy signs of Graves?

A

Pre-tibial myxoedema

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9
Q

What investigations should be done in thyrotoxicosis?

A

Bloods
Antibodies
Isotope scan
Eye testing

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10
Q

What may be found on bloods in thyrotoxicosis?

A

Decreased TSH, increased T3/4
Increased calcium
Increased LFTs

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11
Q

What antibodies should be checked for in thyrotoxicosis?

A

TSH receptor

TPO

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12
Q

What may be found on isotope scan in thyrotoxicosis?

A

Increased in Graves’

Decreased in thyroiditis

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13
Q

What should be done on eye testing in thyrotoxicosis?

A

Acuity
Fields
Movements

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14
Q

What % of cases of thyrotoxicosis is caused by Graves?

A

60%

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15
Q

What is the male:female ratio of Graves?

A

M:F = 1:9

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16
Q

What age is Graves disease most common?

A

40-60 years

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17
Q

What are the clinical features of Graves disease?

A

Diffuse goitre with increased iodine uptake

Opthalmopathy and dermopathy

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18
Q

What are the triggers for Graves disease?

A

Stress
Infection
Childbirth

19
Q

What other conditions is Graves disease associated with?

A

T1DM
Vitiligo
Addison’s

20
Q

What are the other causes of thyrotoxicosis?

A

Toxic multinodular goitre
Toxic adenoma
Thyrotoxic phase of thyroiditis
Drugs

21
Q

What happens in a toxic multinodular goitre?

A

An autonomous nodule develops on a background of an multinodular goitre

22
Q

Where are toxic multinodular goitres common?

A

Elderly

Iodine deficient areas

23
Q

What does the iodine scan show in a toxic multinodular goitre?

A

Hot nodules

24
Q

What is a toxic adenoma?

A

A toxic hot nodule producing T3 and T4

25
What conditions can cause a thyrotoxic phase of thyroiditis?
Hashimotos De Quervain's Subacute lymphocytic thyroiditis
26
What drugs can cause thyrotoxicosis?
Thyroxine | Amiodarone
27
What is involved in the medical management of thyrotoxicosis?
Symptomatic management | Anti-thyroid drugs
28
What can be used in the symptomatic management of thyrotoxicosis?
Beta blockers, e.g. propanolol 40mg/6 hours
29
What anti-thyroid drug can be used in thyrotoxicosis?
Carbimazole
30
What is the mechanism of action of carbimazole?
Inhibits TPO
31
How should the dose of carbimazole be determined?
Titrate according to TFTs | Completely block, and replace with thyroxine
32
How long should carbimazole be given in Grave's disease?
12-18 months
33
What % of patients relapse after 12-18 months of carbimazole treatment in Graves disease?
50%
34
What should be done if a patient relapses after 12-18 months in Graves disease?
Surgery or radioiodine
35
What are the side effects of carbimazole?
Agranulocytosis
36
What is involved in the radiological management of thyrotoxicosis?
Radio-iodine
37
What happens following radioiodine treatment for thyrotoxicosis?
Most become hypothyroid
38
What are the contraindications to radioiodine treatment in thyrotoxicosis?
Pregnancy | Lactation
39
What is involved in the surgical management of thyrotoxicosis?
Thyroidectomy
40
What are the potential adverse effects of thyroidectomy?
Recurrent larygneal nerve damage leading to voice hoarseness Hypoparathyroidism Hypothyroidism
41
What are the features of a thyroid storm?
``` ↑temp Agitation, confusion, coma Tachycardia, AF Acute abdomen Heart failure ```
42
What are the precipitants of a thyroid storm?
Recent thyroid surgery or radio-iodine Infection MI Trauma
43
How is a thyroid storm managed?
1. Fluid resuscitation + NGT 2. Bloods: TFTs + cultures if infection suspected 3. Propranolol PO/IV 4. Digoxin may be needed 5. Carbimazole then Lugol’s Iodine 4h later to inhibit thyroid 6. Hydrocortisone 7. Rx cause

3: MED2 Y3 - Endocrinology [5] (18 decks)

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