Endocrinology - hyperthyroidism Flashcards

1
Q

What is Grave’s disease?

A

An autoimmune hyperthyroidism

TSH receptor antibodies cause a primary hyperthyroidism (mimic TSH)

Most common cause of hyperthyroidism

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2
Q

What is toxic multinodular goitre?

A

Nodules develop on thyroid that act independently of negative feedback and continuously produce T3 and T4

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3
Q

Causes of hyperthyroidism

A

Grave’s disease

Toxic multinodular goitre

Solitary toxic thyroid nodule

Thyroiditis (e.g. De Quervain’s, Hashimoto’s, postpartum and drug-induced thyroiditis)

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4
Q

Features of hyperthyroidism

A

Anxiety and irritability

Sweating and heat intolerance

Tachycardia

Weight loss

Fatigue

Frequent loose stools

Sexual dysfunction

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5
Q

Additional features seen in Grave’s disease

A

Diffuse goitre (without nodules)

Graves eye disease

Bilateral exophthalmos

Pretibial myxoedema

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6
Q

What is exophthalmos?

A

Bulging of eyeball forward

Due to inflammation and hypertrophy of tissue behind the eye

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7
Q

What is pretibial myxoedema?

A

Dermatological condition specific to Grave’s disease

Mucin deposits under the skin in the pre-tibial area (shin)

This gives a discoloured, waxy and oedematous appearance to the skin over this area

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8
Q

Additional features seen in Toxic multinodular goitre

A

Goitre with firm nodules

Most patients are aged over 50

Second most common cause of thyrotoxicosis (after Grave’s)

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9
Q

What is a solitary toxic thyroid nodule? Treatment?

A

Where a single abnormal thyroid nodule is acting alone to release thyroid hormone.

Usually benign adenomas.

Treated with surgical removal of the nodule.

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10
Q

What is De Quervain’s thyroiditis?

A

Presentation of a viral infection with fever, neck pain and tenderness, dysphagia and features of hyperthyroidism.

Usually is a self-limiting condition

Supportive treatment with NSAIDs and beta-blockers for hyperthyroid symptom relief

There is a hyperthyroid phase followed by a hypothyroid phase as the TSH level falls due to negative feedback

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11
Q

What is a complication of hyperthyroidism?

A

Thyrotoxic crisis

It is a more severe presentation of hyperthyroidism with pyrexia, tachycardia and delirium.

Need admission for monitoring and is treated the same way as any other presentation of hyperthyroidism

Although they may need supportive care with fluid resuscitation, anti-arrhythmic medication and beta-blockers.

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12
Q

Management of hyperthyroidism

A

Medical management:

  • Carbimazole (first line)
  • Propylthiouracil (second line)

Radioactive iodine

Beta-blockers e.g. propranolol can be used (particularly in thyrotoxic crisis) - for symptom control only, doesn’t treat underlying cause

Surgery - a definitive option

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13
Q

Carbimazole

A

First line anti-thyroid drug

Normalises thyroid function in 1-2 months

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14
Q

Risk of PTU

A

Small risk of severe hepatic reactions including death

Why carbimazole is preferred

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15
Q

Radioactive iodine - process

A

Drinking radioactive iodine

This is taken up by the thyroid gland and destroys thyroid tissue

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16
Q

Radioactive iodine - advice to give to patients

A

Can be left hypothyroid after and need levothyroxine treatment

There are strict rules where the patient:

  • Must not be pregnant and are not allowed to get pregnant within 6 months
  • Must avoid close contact with children and pregnant women for 3 weeks
  • Limit contact with anyone for several days after receiving the dose
17
Q

What are some side effects of thyroid surgery to treat hyperthyroidism?

A

Hypothyroidism - needing levothyroxine treatment

Damage to parathyroid glands - leading to hypoparathyroidism

Recurrent laryngeal nerve damage leading to hoarse or weak voice