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Year 2 > Drug-Induced Hyperthyroidism > Flashcards

Drug-Induced Hyperthyroidism Flashcards

1
Q

What drug commonly causes hyperthyroidism and why

A

AMIODARONE

High iodine content - hyperthyroidism

Inhibits conversion of T4 to T3 (hypothyroidism

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2
Q

Role of AMIODARONE

A

Anti-arrythmic

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3
Q

What elements can cause hyperthyroidism if found in a drug

A

Iodine

Lithium

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4
Q

What are the clinical presentations of drug-induced hyperthyroidism

A
  1. Palpatations
  2. Diarrhoea
  3. Weight LOss
  4. Heat Intolerance
  5. Tremors
  6. Warm
  7. Hyperkinesis
  8. Anxiety
  9. Diffuse Goitre

DIFFUSE GOITRE and WASTING are the biggest signs

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5
Q

In elderly how can drug-induced hyperthyroidism be caused

A
  1. Atrial Fibrillation

2. Heart Failure

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6
Q

In children, how can drug-induced hyperthyroidism be caused

A
  1. Excessive height or GR

2. Behavioural problems (ADHD)

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7
Q

How is Hyperthyroidism treated

A
  1. PROPRANOLOL (controls symptoms)
  2. PROPYLTHIOURACIL (stops conversion of T4 to T3)
  3. ORAL Carbimazole and THYROXINE which reduces hypothyroidism risk
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8
Q

Why do half of those with Graves’ relapse after 2 years

A

Discontinue treatment after two years

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9
Q

What is the main side-effect of treating hypothyroidism

A

Agranulocytosis - leads to Low white blood cells count (leukopenia)

Rash (less common)

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10
Q

When should drugs stop being given to patients with Graves’ or hypothyroidism

A

If they get throat, mouth ulcers

Fevers

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11
Q

When should radioactive iodine be given

A

4 days after anti-thyroid drugs have been stopped

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12
Q

How long does 131-I take for normal thyroid to function

A

4-12 weeks after radioactive iodine

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13
Q

When can radioactive iodine be contraindicated

A

Pregnancy and breast feeding

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14
Q

Side-effects of giving radioactive iodine

A

Discomfort in the ne ck and hyperthyroidism initially

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15
Q

When should surgery be given to individuals with hyperthyroidism

A
  1. Those with large goitre, poor response to drugs or experiencing severe side-effects from treatment
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16
Q

What is subtotal thyroidectomy

A

Leaves a bit of thyroid (nota ll removed) to preserve function

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17
Q

When is subtatotal thyroidectomy given

A

When patient is euthyroid

18
Q

When is a total thyroidectomy given

A

Those with large goitre, malignancy in nodule or Graves’

19
Q

What should we do before surgery occurs

A

Stop antithyroid drugs 10-14 days before

GivePotassium Iodide to reduce vascularity of gland

20
Q

Side-Effectt of surgery for hyperthyroidism

A

Hypothyroid

Tracheal compression from post-operative bleeding
Laryngeal nerve paslsy (sore throat)
Trnasient hypocalcaemia (removal of PTH gland)

21
Q

How can Hashimoto’s thyroiditis be treated

A

Levothyroxine therapy to shrink goitre even when patient is not hypothyroid

22
Q

How is a thyroid crisis treated

A 
1. LARGE DOSES OF:
Oral CARBIMAZOLE
ORAL PROPRANOLOL
ORAL POTASSIUM IODIDE
IV HYDROCORTISONE
23
Q

Role of ORAL POTASSIUM IODIDE

A

Block acutely the release of thyroid hormone from glands

24
Q

Role of IV HYDROCORTISONE

A

Inhibits T4 to T3

25
Q

Signs of children with hypothyroidism

A

Slow growth velocity

Poor School performance

26
Q

How are papillary and follicular carcinomas treated

A

Total thyroidectomy

Ablative radioactive iodine

27
Q

Problem with anapaestic carcinomas

A
  1. Does not respond to radioactive iodine

External radiotherapy provides brief respite

28
Q

How to treat medullary carcinoma

A

Thyroidectomy and lymph node removal

29
Q

How is hypothyroidism treated

A

Oral LEVOTHYROXINE

30
Q

What should we look out for in patients with ischaemic heart disease who are hypothyroid

A

Start on lower dose

31
Q

What do we increase the risk of if we give LEVOTHYROXINE

A

AF and Osteoporosis if we suppress TSH completely

32
Q

How is primary hypothyroidism treated

A
  1. Those titrated until TSH normalises

2. Check T4 levels 6-8 weeks after dose adjustment

33
Q

Why can’t we check TSH levels in secondary hypothyroidism

A

TSH will always be low

34
Q

What do we monitor in secondary hypothyroidism

A

T4

35
Q

How do we treat Myxoedema Coma and what people does this usually effect

A

IV T3 and Glucose infusion

Old people - confusion

36
Q

How is myxoedema coma caused

A

EXTREMELY LOW T4

37
Q

What in blood tests would indicate hypothyroidism

A
  1. Normocytic or microcytic anaemia or microcytic in women due to coeliac’s
  2. Raised serum aspartate transferase levels
  3. Increased serum creatinine kinase levels
  4. Hypercholesterolaemia
  5. Hyponatraemia due to increased ADH
38
Q

Where is iodine deficiency common

A

Netherlands, India, Russia and Africa

39
Q

Role of Thyroid peroxides

A

Production and storage of thyroid hormones

40
Q

Problem with Postpartum thyroiditis

A

Can be misdiagnosed as postpartum depression (Temporary phase after pregnancy)

41
Q

Four ways hypothyroidism can be drug-induced

A
  1. CARBIMAZOLE
  2. LITHIUM
  3. AMIODARONE
  4. INTERFERON
42
Q

What often causes Goitre

A

Iodine Deficiency

Year 2 (155 decks)

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