Hyperthyroidism Flashcards
What is hyperthyroidism?
Overproduction of the thyroid hormone from the thyroid gland
What is the main cause of hyperthyroidism?
Grave’s disease
What is other common cause of hyperthyroidism?
Toxic multinodular goitre
What is a possible drug cause of hyperthyroidism?
Amiodarone
Lithium
What are the main presentations of hyperthyroidism?
Anxiety and irritability
Sweating and heat intolerance
Tachycardia
Weight loss
Fatigue
Frequent loose stools
Sexual dysfunction
What are additional presentations of grave’s disease?
Bilateral exophthalmos
Pretibial myxoedema
What are additional presentations of toxic multinodular goitre?
Goitre with firm nodules
What antibodies are present with Grave’s disease?
Anti-TSH antibodies
What will the level of TSH, T3 and T4 be?
Low TSH
high T3 and T4
What is the management of graves disease?
Carbimazole
Complication: Agranulcytosis
What is the management of toxic multinodular goitre?
Radioiodine ablation
What would be seen with a Nuclear scintigraphy in someone with a toxic multinodular goitre?
Patchy uptake
What would you find on Thyroid scintigraphy if the patient was presenting with Grave’s rather than mulitnodular goitre?
Diffuse, homogenous, increased uptake of radioactive iodine
What drug can be prescribed to help control the symptoms of graves?
Propranolol
What are the general symptoms of throtoxicosis?
Weight loss
‘Manic’, restlessness
Heat intolerance
What are the cardiac symptoms of thyrotoxicosis?
palpitations, tachycardia
high-output cardiac failure may occur in elderly patients
What are the skin symptoms of thyrotoxicosis?
Increased sweating
Pretibial myxoedema
Thyroid acropachy:
What gastrointestinal feature can present with thyrotoxicosis?
Diarrhoea
What does thyrotoxicosis mean?
The syndrome caused by an abnormal and excessive quantity of thyroid hormone in the body.
What is primary hyperthyroidism?
Due to thyroid pathology. The thyroid itself that is behaving abnormally and producing excessive thyroid hormone.
What is secondary hyperthyroidism?
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.
Where is the pathology in primary hyperthyroidism?
In the thyroid gland itself
Where is the pathology with secondary hyperthyroidism?
In the pituitary or hypothalamus
What is Grave’s disease due to?
Autoimmune disease
Abnormal antibodies (TSH receptor antibodies) produced by the immune system that mimic TSH and stimulate the TSH receptors on the thyroid
What is the name of the abnormal antibodies produced by the immue system in Grave’s disease?
TSH receptor antibodies
How can toxic multinodular goitre cause hyperthyroidism?
Nodules develop on the thyroid gland that act independently of the normal feedback system and continuously produce excessive thyroid hormone.
What is exopthalmous?
Inflammation, swelling and hypertrophy of the tissue behind the eyeball that forces the eyeball forward.
What are the other possibel causes of hyperthyroidism?
Solitary toxic thyroid nodule
Thyroiditis
What does thyroiditis include?
De Quervain’s
Hashimoto’s
Postpartum and drug-induced thyroiditis
What does thyroiditis include?
De Quervain’s
Hashimoto’s
Postpartum and drug-induced thyroiditis
What is a thyroid storm?
Another term for thyrotoxic crisis
Severe but rare presentation of hyperthyroidism
How can a thyrotoxic crisis present?
Pyrexia
Tachycardia
Delirium
What is the management of a thyrotoxic crisis?
Admission
Fluid
Beta-blockers
Anti-ematics
When would radio-iodine ablation be contraindicated?
Thyroid eye disease- can worsen symptoms
Pregnancy
What are potential complications of a thyroidectomy?
Hypoparathyroidism
Hypocalcaemia
Laryngeal nerve damage
Bleeding.
What medication can be used in teh management of a thyroid storm?
IV propranolol
IV digoxin
Propylthiouracil
What type of goitre does graves disease present with?
Smooth, enlarged, non-tender goitre
What is a potential complication of radioiodine therapy?
Hypothyroidism
How long is carbimazole usually given?
12-18 months
What is pretibial myxoedema due to?
Deposits of mucin under the skin on the anterior aspect of the leg
