Hyperthyroid

Question 1

Excess of either thyroid hormones or preformed thyroid hormones; examples are Grave’s disease, Toxic Goiter, Thyroiditis and meds

Answer 1

Hyperthyroidism

Question 2

Examples of causes of Hyperthyroidism

Answer 2

Grave's disease
Toxic Multinodular Goiter
Thyroiditis
Excessive Thyroid Hormone dosage
Excessive Iodine load

Question 3

What is the Jod-Basedow phenomenon?

Answer 3

hyperthyroidism following admin of iodine (not a normal phenomenon, should dec. function; sign of abnormality)

Question 4

The signs/symptoms of Hyperthyroidism are due to…

Answer 4

Inc. metabolism and target organ hyperfunction

Question 5

Signs/Symptoms of Hyperthyroidism

Answer 5

Heat intolerance
Inc. HR
Increased appetite
Hyperactive reflexes
Lid retraction/lag
Increased BP (systolic)

Question 6

Cause of Hyperthyroidism; MOST COMMON; more common in females; thyroid stimulating immunoglobulins (TSIs) activate the TSH receptor on thyroid cells; can also see ophthalmopathy due to proliferation of retro-orbital smooth muscle and fibroblasts

Answer 6

Grave’s Disease

Question 7

Ophthalmic issue associated with Grave’s disease

Answer 7

Grave’s Ophthalmopathy (proliferation of retro-orbital smooth muscle and fibroblasts)

Question 8

Histology findings for Grave’s Disease (autoimmune hyperthyroidism)

Answer 8

Hyperplastic
Colloid is ABSENT
Lymphocytic infiltration

Question 9

Cause of Hyperthyroidism; nodules in thyroid acquire autonomy over time; asymmetric, nodular gland

Answer 9

Toxic Multinodular Goiter

Question 10

Histology (can/can’t) distinguish between a Toxic and Non-toxic Nodular Goiter

Answer 10

Can’t

Question 11

Ways to help diagnose the cause of Hyperthyroidism

Answer 11

Antibody testing (high TSI in Grave's)
Nuclear studies (thyroid scanning)
Thyroglobulin levels (indicate exogenous thyroid hormone ingestion)

Question 12

Inflammation of the thyroid

Answer 12

Thyroiditis

Question 13

Subacute inflammation of the Thyroid; PAINFUL, tender and swollen thyroid that can result in HYPERthyroidism; histology shows granulomatous inflammation with replacement with giant cells

Answer 13

De Quervain’s Thyroiditis

Question 14

Main treatments for Hyperthyroidism

Answer 14

Anti-thyroid drugs (Methimazole, Propylthiouracil)
Radioactive Iodine
Surgery

Question 15

Examples of Anti-Thyroid drugs (used for Hyperthyroidism, like Grave’s) (2 total)

Answer 15

Methimazole

Propythiouracil

Question 16

MOA of Anti-Thyroid drugs (Methimazole and Propythiouracil)

Answer 16

Blocks all 4 steps!

1. Blocking Thyroid Peroxidase
2. Blocks the organification of Iodide
3. Coupling of MIT/DIT
4. T4 –> T3 conversion (only by PTU)

Question 17

Side effects of Anti-Thyroid drugs (Methimazole and Propythiouracil)

Answer 17

Rash

Liver Damage*
Agranulocytosis*

*uncommon, but very dangerous

Question 18

Extreme example of SEVERE Hyperthyroidism that is precipitated by infection, surgery or drugs; Endocrine EMERGENCY with high mortality; treat with Anti-Thyroid drugs (Propythiouracil) or underlying cause

Answer 18

Thyroid Storm

Question 19

Treatments for Thyroid Storm

Answer 19

Anti-Thyroid drugs (only Propythiouracil)
Propanolol (for palpitations)
Treat underlying cause

Question 20

Three antibody-mediated clinical features of Grave’s disease

Answer 20

1. Opthalmopathy
2. Dermopathy (물집)
3. Acropathy (clubbing of fingers)

Question 21

TSH, T4, T3 levels of primary hyperthyroidism

Answer 21

low, high, high

Question 22

TSH, T4, T3 levels of secondary hyperthyroidism

Answer 22

high, high, high

Question 23

TSH, T4, T3 levels of subclinical hyperthyroidism

Answer 23

low, normal, normal

Question 24

What are the 3 phases of thyroiditis

Answer 24

phase 1: hyperthyroid
phase 2: normal
phase 3: hypothyroid

Phase 4: recovery