Hyperthyroidism Flashcards

1
Q

What is Graves’ disease?

A

Autoimmune
Antibodies bind to and stimulate TSH receptor in the thyroid
Cause goitre and hyperthyroidism

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2
Q

What symptoms can be seen because of the antibodies in graves?

A

Symptoms due to high BMR, goitre and exophthalmos * due to antibody
And another antibody can cause pretibial myxoedema

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3
Q

What happens if you give radio iodine = to a gravies pX?

A

Whole gland will absorbed iodine due to activity and whole will be seen

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4
Q

What is Plummer’s disease? ( Toxic Nodular goitre )

A

Not autoimmune

Benign adenoma that is overactive at making thyroxine

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5
Q

What are the differences between graves’ and toxic nodular goitre disease?

A

No antibodies in plummers so not pretibial myeoxma and exophaaltus

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6
Q

What will Toxic Nodular look like on iodine scan?

A

Not a uniform scan, one part where the benign part is. Not very active

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7
Q

What are the effects of thyroxine on the sympathetic nervous system?

A

Sensitises beta adrenoceptors to ambient levels of adrenaline and noraadrenaline

–> apparent sympathetic activation

–> tachycardia, palpitations, tremor in hands, lid lag

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8
Q

What are the symptoms of hyperthyroidism?

A
Weight loss despite increased appetite
Breathlessness, 
palpitations, tachycardia
Sweating
Heat intolerance
Diarrhoea
Lid lag and other sympathetic features
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9
Q

What is a thyroid storm? (thyrotoxic crisis)

A
  • Medical emergency : 50% mortality if untreated
  • Blood results confirm hyperthyroidism
  • Hyperpyrexia (>41)
  • tachycardia/arrhythmia
  • Cardiac failure
  • Delirium/frank psychosis
  • Hepatocellular dysfunction; jaundice

Any 2+ = thyroid storm

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10
Q

What are the treatment options?

A

Thyroidectomy ( surgery )

Drugs

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11
Q

What are the classes of drugs used in the treatment of hyperthyroidism?

A
  • > Thionamides - Block the enzyme to make thyroxine ( propylthiouracil (PTU) carbimazole (CBZ)
  • > Potassium Iodide
  • > Radioiodine
  • > B-blockers ( stop sympathetic symptoms )
  • First 3 drugs reduce thyroid hormone synthesis
    b blockers help with symptoms
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12
Q

What are the unwanted actions of thionamides?

A

Agranulocytosis (usually reduction in neutrophils) - rare and reversible on withdrawal of drug.
rashes (relatively common)

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13
Q

What is the role of B blockers in thyrotoxicosis?

A

Several weeks for ATDs to have clinical effects eg reduced tremor, slower heart rate, less anxiety

SO we used B blocker 1st:

NON-selective (ie b1 & b2) b blocker
eg propranolol
achieves these effects in the interim

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14
Q

How to prepare patients for surgery?

A

Excess KI to inhibit thyroid hormone synthesis and secretion

  • short term only until surgery to control blood loss and size of gland
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15
Q

What are the risks with surgery?

A

Risk of voice change
Risk of also losing parathyroid glands
Scar
Anaesthetic

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16
Q

What is Radioiodine?

A

Swallow a capsule containing about 370 MBq (10 mCi) of the isotope I (131)
Contraindicated in pregnancy * because it can cause hypothyroidism in the baby due to the ability to cross placenta
Need to avoid children and pregnant mums for a few days

For scans only (not treatment), 99-Tc pertechnetate is an option.

17
Q

What is Viral thyroiditis? * De Quervains’

A

Viral: * suddenly after painful neck, body will release all thyroxine and become hyperthyroid. the thyroid will start making the virus and then next month they become hypothyroidism

Painful dysphagia
Hyperthyroidism
Pyrexia
Thyroid inflammation

18
Q

What does iodine scan look like for a pc with viral thyroiditis?

A

No uptake as the thyroid cells are not working - viral thyroiditis

19
Q

How does postpartum thyroiditis differ?

A

Postpartum thyroiditis similar but no pain and only occurs after pregnancy