Endocrine thyroid disorders

Question 1

THYROID HORMONES- negative feedback loop?

Answer 1

High levels of T3+T4
->suppress func/ prodn of TSH/ TRH
->inhibits own production

Question 2

HYPERTHYROIDISM LEVELS?

Answer 2

HIGH T3 + T4 LOW TSH

too much thyroid hormone
inc metabolism and activity

Question 3

HYPERTHYROIDISM

SYMPTOMS?

Answer 3

HYPERACTIVITY
INSOMNIA
HEAT INTOLERANCE
INCREASED APPETITE
WEIGHT LOSS
DIARRHOEA
GOITRE

Question 4

HYPERTHYROIDISM- TREATMENT

1st LINE?
2nd LINE?

Answer 4

1st LINE? CARBIMAZOLE

2nd LINE? PROPYLTHIOURACIL

Question 5

HYPERTHYROIDISM

CARBIMAZOLE MHRA WARNINGS? CM-NAP

Answer 5

Neutropenia+Agranulocytosis-> sore throat, malaise, fever
Congenital Malformations-> use effective contraception
Acute Pancreatitis-> report & stop ASAP (severe abdominal pain, GLP1s & flozins)

Note: B-blockers can be used for symptomatic relief in primary hyperthyroidism

Question 6

HYPERTHYROIDISM

PROPYLTHIOURACIL cautioned in..?

Answer 6

liver disorder-> jaundice, dark urine, nausea

as can cause hepatic reactions

Question 7

Note: B-blockers can be used for symptomatic relief in what?

Answer 7

PRIMARY HYPERTHYROIDISM

Question 8

HYPERTHYROIDISM- TREATMENT

GRAVE’S DISEASE
1st LINE?

Answer 8

RADIOACTIVE IODINE
But if remission is likely with anti-thyroids, consider carbimazole

Iodine/surgery unsuitable? Consider carbimazole
Given as a block & replace regimen in combo w/ levothyroxine for 12-18 months

Question 9

HYPERTHYROIDISM- TREATMENT

PREGNANCY
1st TRIMESTER?
2nd+3rd TRIMESTER?

Answer 9

1st TRIMESTER? Propylthiouracil (carbimazole has congenital defects)

2nd+3rd TRIMESTER? Carbimazole (>propylthiouracil’s hepatotoxicity)

Question 10

HYPOTHYROIDISM LEVELS?

Answer 10

LOW T3 + T4 HIGH TSH

dec metabolism and activity

Question 11

HYPOTHYROIDISM

Answer 11

FATIGUE
WEIGHT GAIN
CONSTIPATION
DEPRESSION
DRY SKIN
INTOLERANCE TO COLD
MENSTRUAL IRREGULARITIES
REDUCED METABOLIC ACTIVITY!

Question 12

HYPOTHYROIDISM- TREATMENT

1st LINE?

Answer 12

LEVOTHYROXINE

Question 13

HYPOTHYROIDISM- TREATMENT

LEVOTHYROXINE
Monitor TSH how often?

Answer 13

3 months till stable, then yearly thereafter

Question 14

HYPOTHYROIDISM- TREATMENT

LEVOTHYROXINE
How to take it?

Answer 14

Take medicine in AM, at least 30mins before breakfast/ caffeinated drinks

Question 15

HYPOTHYROIDISM- TREATMENT

LEVOTHYROXINE

what to remember about brands?

Answer 15

Some patients can feel symptoms if alternating between brands

Question 16

HYPOTHYROIDISM TREATMENT

LIOTHYRONINE?

Answer 16

Rare
More rapid+potent (20-25mcg= 100mcg levo)
Non-UK brands may not be bioqeuivalent

Question 17

double check NICE and extra notes