Hyperthyroidism

Question 1

What is hyperthyroidism?

Answer 1

Overproduction of the thyroid hormone from the thyroid gland

Question 2

What is the main cause of hyperthyroidism?

Answer 2

Grave’s disease

Question 3

What is other common cause of hyperthyroidism?

Answer 3

Toxic multinodular goitre

Question 4

What is a possible drug cause of hyperthyroidism?

Answer 4

Amiodarone
Lithium

Question 5

What are the main presentations of hyperthyroidism?

Answer 5

Anxiety and irritability
Sweating and heat intolerance
Tachycardia
Weight loss
Fatigue
Frequent loose stools
Sexual dysfunction

Question 6

What are additional presentations of grave’s disease?

Answer 6

Bilateral exophthalmos
Pretibial myxoedema

Question 7

What are additional presentations of toxic multinodular goitre?

Answer 7

Goitre with firm nodules

Question 8

What antibodies are present with Grave’s disease?

Answer 8

Anti-TSH antibodies

Question 9

What will the level of TSH, T3 and T4 be?

Answer 9

Low TSH

high T3 and T4

Question 10

What is the management of graves disease?

Answer 10

Carbimazole

Complication: Agranulcytosis

Question 11

What is the management of toxic multinodular goitre?

Answer 11

Radioiodine ablation

Question 12

What would be seen with a Nuclear scintigraphy in someone with a toxic multinodular goitre?

Answer 12

Patchy uptake

Question 13

What would you find on Thyroid scintigraphy if the patient was presenting with Grave’s rather than mulitnodular goitre?

Answer 13

Diffuse, homogenous, increased uptake of radioactive iodine

Question 14

What drug can be prescribed to help control the symptoms of graves?

Answer 14

Propranolol

Question 14

What are the general symptoms of throtoxicosis?

Answer 14

Weight loss
‘Manic’, restlessness
Heat intolerance

Question 15

What are the cardiac symptoms of thyrotoxicosis?

Answer 15

palpitations, tachycardia
high-output cardiac failure may occur in elderly patients

Question 16

What are the skin symptoms of thyrotoxicosis?

Answer 16

Increased sweating
Pretibial myxoedema
Thyroid acropachy:

Question 17

What gastrointestinal feature can present with thyrotoxicosis?

Answer 17

Diarrhoea

Question 18

What does thyrotoxicosis mean?

Answer 18

The syndrome caused by an abnormal and excessive quantity of thyroid hormone in the body.

Question 19

What is primary hyperthyroidism?

Answer 19

Due to thyroid pathology. The thyroid itself that is behaving abnormally and producing excessive thyroid hormone.

Question 20

What is secondary hyperthyroidism?

Answer 20

Condition where the thyroid is producing excessive thyroid hormone as a result of overstimulation by thyroid stimulating hormone
The pathology is in the hypothalamus or pituitary.

Question 21

Where is the pathology in primary hyperthyroidism?

Answer 21

In the thyroid gland itself

Question 22

Where is the pathology with secondary hyperthyroidism?

Answer 22

In the pituitary or hypothalamus

Question 23

What is Grave’s disease due to?

Answer 23

Autoimmune disease
Abnormal antibodies (TSH receptor antibodies) produced by the immune system that mimic TSH and stimulate the TSH receptors on the thyroid

Question 24

What is the name of the abnormal antibodies produced by the immue system in Grave's disease?

Answer 24

TSH receptor antibodies

Question 25

How can toxic multinodular goitre cause hyperthyroidism?

Answer 25

Nodules develop on the thyroid gland that act independently of the normal feedback system and continuously produce excessive thyroid hormone.

Question 26

What is exopthalmous?

Answer 26

Inflammation, swelling and hypertrophy of the tissue behind the eyeball that forces the eyeball forward.

Question 27

What are the other possibel causes of hyperthyroidism?

Answer 27

Solitary toxic thyroid nodule Thyroiditis

Question 28

What does thyroiditis include?

Answer 28

De Quervain’s Hashimoto’s Postpartum and drug-induced thyroiditis

Question 28

What does thyroiditis include?

Answer 28

De Quervain’s Hashimoto’s Postpartum and drug-induced thyroiditis

Question 29

What is a thyroid storm?

Answer 29

Another term for thyrotoxic crisis Severe but rare presentation of hyperthyroidism

Question 30

How can a thyrotoxic crisis present?

Answer 30

Pyrexia Tachycardia Delirium

Question 31

What is the management of a thyrotoxic crisis?

Answer 31

Admission Fluid Beta-blockers Anti-ematics

Question 32

When would radio-iodine ablation be contraindicated?

Answer 32

Thyroid eye disease- can worsen symptoms Pregnancy

Question 33

What are potential complications of a thyroidectomy?

Answer 33

Hypoparathyroidism Hypocalcaemia Laryngeal nerve damage Bleeding.

Question 34

What medication can be used in teh management of a thyroid storm?

Answer 34

IV propranolol IV digoxin Propylthiouracil

Question 35

What type of goitre does graves disease present with?

Answer 35

Smooth, enlarged, non-tender goitre

Question 36

What is a potential complication of radioiodine therapy?

Answer 36

Hypothyroidism

Question 37

How long is carbimazole usually given?

Answer 37

12-18 months

Question 38

What is pretibial myxoedema due to?

Answer 38

Deposits of mucin under the skin on the anterior aspect of the leg