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py365 af > Hyper/Hypothyroidism > Flashcards

Hyper/Hypothyroidism Flashcards

1
Q

What is hypothyroidism

A

A decrease in the level of thyroid hormone in the blood

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2
Q

What can hypothyroidism lead to

A

SAN and automaticity are reduced, leading to bradycardia

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3
Q

What occurs when noradrenaline and adrenaline bind to alpha receptors

A

causes blood vessels to constrict, which increases TPR

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4
Q

What are the symptoms of hypothyroidism

A
  1. Weight gain, reduced appetite, decreased body temperature, cold intolerance
  2. Bradycardia, hypertension, decreased Beta receptors or increased alpha receptors
  3. constipation
  4. fatigue, depression, impaired memory, impaired concentration
  5. dry skin, hair loss, brittle hair
  6. thin nails, brittle nails
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5
Q

What are the causes of hypothyroidism

A

HARRISMD
1. hormone resistance syndrome- TRH resistance
2. autoimmune thyroiditis- autoimmune destruction of thyroid gland (Hashimoto’s thyroiditis)
3. Radiation therapy- radio iodine ablation and tradition radiotherapy to the neck
4. Reidel thyroiditis- an infiltrative thyroid disorder
5. Iodine deficiency- lack of iodine required for thyroid hormone synthesis
6. Surgery- total thyroidectomy
7. Malignancy- lymphoma, metastatic disease to the thyroid, thyroid malignancy
8. Drugs- amiodarone, lithium, immune checkpoint inhibitors

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6
Q

What is Hashimoto’s disease

A

autoimmune destruction of thyroid gland
- may or may not be associated with hypothyroidism
- most common cause of hypothyroidism but in some patients, doesn’t necessarily lower thyroid levels

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7
Q

Outline the treatment of hypothyroidism

A
  1. Replacement therapy with thyroxine
    - monitor effectiveness by measuring TSH
    - sufficient T4 will suppress TSH secretion by negative feedback so TSH levels will drop in blood
  2. Typically also need calcium and vitamin D therapy
    - thyroid hormones also produce calcitonin, which regulates Ca metabolism in body, so need to supplement
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8
Q

which drugs can induce goitre

A
  1. Lithium- used in treatment of bipolar depression
  2. Iodides- contained in vitamin preparations and some cough remedies
  3. Amiodarone- used for treatment of AF
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9
Q

What is hyperthyroidism

A

Elevated levels of thyroid hormones in the blood than is needed in the body

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10
Q

What is another name for hyperthyroidism

A

Overactive thyroid, thyrotoxicosis

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11
Q

How else can hyperthyroidism occur

A

can also occur when too much replacement thyroxine (levothyroxine) is taken as a treatment for underactive thyroid

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12
Q

What are the symptoms of hyperthyroidism

A
  1. weight loss, increased appetite, increased body temperature, heat intolerance
  2. tachycardia, palpitations, arrhythmias, hypertension
  3. diarrhoea
  4. anxiety, nervousness, irritability, insomnia, tremors
  5. sweating, hair growth, fine soft hair
  6. nail growth, onycholysis
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13
Q

What is Graves disease

A

Most common condition that drives hyperthyroidism
- autoimmune condition where the body attacks the thyroid, making it overactive
- affects 0.5% of people
- 7.5x more prevalent in females
- typified by low TSH and high T4

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14
Q

What would the TSI level be like in a patient with Graves disease

A

TSI level would be abnormally high

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15
Q

What is TSI

A

A form of immunoglobulin G (IgG) that can bind to thyrotropin (TSH) receptors on the thyroid gland
- mimics action of TSH, causing excess secretion of T4 and T3

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16
Q

What are the symptoms of Graves disease

A
  1. Exophthalmos- bulging of the eye anteriorly out of orbit
  2. Goitre- swelling in neck due to enlarged thyroid gland
  3. Pre tibial myxoedema or infiltrative dermopathy- rare complication mostly seen on shins and is characterised by swelling and lumpiness of lower legs
17
Q

What are the 3 treatments available for Graves disease

A
  1. Drug therapy
  2. Surgical- removing parts of the thyroid
  3. Radioactive iodine gets taken up by thyroid and will kill some of the cells in the thyroid
    - reducing its ability to produce thyroid hormone
18
Q

Outline the drug treatments for hyperthyroidism that try to reduce synthesis of thyroid hormones

A
  1. Propylthiouracil- prevents the peripheral conversion of T4 to T3
  2. Carbimazole/methimazole- anti thyroid drugs that act by inhibition of the synthesis of thyroid hormones by preventing the incorporation of the iodide into the thyroglobulin
19
Q

Outline the drug treatments that manage side effects of hyperthyroidism

A
  1. beta blockers may be used for rapid relief of adrenergic symptoms and may be used in conjunction with antithyroid drugs
  2. propanalol, metoprolol, and nadolol are licensed for treatment of thyrotoxicosis as an adjunct to antithyroid drug treatment
20
Q

What are the side effects of anti thyroid drugs

A
  1. nausea and vomiting
  2. pruritus and urticarial rashes
  3. leucopaenia (reduction in white blood cells)
  4. fever
  5. cholestatic jaundice

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