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Endocrine > Hyperthyroidism > Flashcards

Hyperthyroidism Flashcards

1
Q

How are the causes of hyperthyroidism categorised

A

Primary
Secondary
Thyrotoxicosis without hyperthyroidism

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2
Q

What are the primary causes of hyperthyroidism

A

Graves disease (70-80%)

Toxic Multinodular Goitre (20%)

Toxic adenoma

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3
Q

What is the epidiiology of graves disease

A

Incidence 2-3 per 1000 per year
More common in females
Usually affects young adults (20-40 years)

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4
Q

What is the pathophysiology of graves disease

A
  • Antibodies produced (anti-TSH antibodies) that bind mimic TSH and continually activate the thyroid gland.
  • Increased release of TH switches off TSH release from anterior pituitary so [TSH]plasma very low and so is TRH release from hypothalamus
  • Thyroid gland may be 2-3x normal size due to hyperplasia. Hyperactivity of cells also apparent.
  • Patient has very high levels of T4
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5
Q

What are signs and symptoms of graves disease (x13)

A

Bulging eyes (Graves’ ophthalmopathy) 30%

Thick, red skin usually on the shins or tops of the feet (Graves’ dermopathy)

Anxiety and irritability

A fine tremor of the hands or fingers

Heat sensitivity and an increase in perspiration or warm, moist skin

Weight loss, despite normal eating habits

Enlargement of the thyroid gland (goiter)

Change in menstrual cycles

Erectile dysfunction or reduced libido

Frequent bowel movements

Fatigue

Rapid or irregular heartbeat (palpitations)

Sleep disturbance

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6
Q

What causes graves opthalmopathy

A

A build up of carbohydrates in the muscles and tissue behind the eyes

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7
Q

What is the Histopathology of a thyroid gland in graves disease

A

If its dissected then it looks meaty (pink dense appearance)

There is increased cell activity and increased cell number (larger, columnar cells with smaller follicles)

Hyperplasia of the acinar epithelium

Reduction of stored colloid

local accumulations of lymphocytes with lymphoid follicle formation

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8
Q

What is Toxic Multinodular Goitre

A

A goitre containing multiple autonomously functioning nodules, resulting in hyperthyroidism.

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9
Q

What triggers thyroid hormone release from the Toxic Multinodular Goitre

A

These nodules function independently of thyroid-stimulating hormone

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10
Q

When should you suspect if there are non-functioning thyroid nodules in the a Toxic Multinodular Goitre

A

Malignancy

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11
Q

What age group gets Toxic Multinodular Goitre

A

Over 50

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12
Q

What is thyrotoxicosis

A

Refers to an abnormal amount of thyroid hormone in the body

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13
Q

How common is Toxic Multinodular Goitre

A

Its the second most common cause of thyrotoxicosis

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14
Q

What condition sees an elevated level of thyroid hormone followed by a hypothyroid phase

A

Subacute (de Quervain’s) thyroiditis

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15
Q

What is Subacute (de Quervain’s) thyroiditis

A

Subacute thyroiditisis an acute inflammatory disease of thethyroidprobably caused by a virus.

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16
Q

What are symptoms of Subacute (de Quervain’s) thyroiditis

A

Symptoms include fever andthyroidtenderness.

17
Q

What age group commonly get Subacute (de Quervain’s) thyroiditis

A

<50 years

18
Q

What is treatment for Subacute (de Quervain’s) thyroiditis

A

Short term steroids and NSAIDS

19
Q

What is thyroid storm

A

Thyroid storm is a rare presentation of hyperthyroidism. It is also known as “thyrotoxic crisis”

20
Q

What are presenting symptoms of thyroid storm

A

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

21
Q

What are treatment options available for hyperthyroidism

A

Anti-thyroid drugs
Radioiodine
Surgery
Beta blockers

22
Q

What is the first line anti-thyroid drug

A

Carbimazole

23
Q

How long does it usually take for carbimazole to work?

A

4-8 weeks for normal thyroid function

Complete remission after 18 months

24
Q

What is the Second line anti-thyroid drug

A

Propylthiouracil

25
Q

Why is Carbimazole preferred over Propylthiouracil

A

Propylthiouracil has a small risk of severe hepatic reactions, including death,

26
Q

How does Radioiodine treatment work

A

Involves drinking a single dose of radioactive iodine. This is taken up by the thyroid gland and the emitted radiation destroys a proportion of the thyroid cells.

27
Q

What is a risk of radio iodine therapy

A

patients can be left hypothyroid afterwards and require levothyroxine replacement.

28
Q

What are the 3 strict rules when using radioiodine therapy

A

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 (depending on the dose)

Limit contact with anyone for several days after receiving the dose

29
Q

Why are beta blockers used to treat hyperthyroidism

A

Beta blockers are used to block the adrenalin related symptoms of hyperthyroidism.

Endocrine (14 decks)

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