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Y2 BRS Endocrinology > Hyperthyroidism > Flashcards

Hyperthyroidism Flashcards

1
Q

What does Grave’s Disease cause?

A
  1. Hyperthyroidism
  2. Smooth goitre (antibodies bind to and stimulate TSH receptor)
  3. Pretibital myxoedema (hypertrophy - growth of soft tissue)
  4. Exophthalmos
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2
Q

What is toxic nodular goitre?

A

Benign adenoma that is overactive at making thyroxine

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3
Q

What is the difference with Grave’s Disease and toxic nodular goitre?

A

Toxic nodular goitre:

  • Not autoimmune
  • No pretibital myxoedema
  • No exophthalmos
  • Goitre not symmetrical
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4
Q

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

A
  1. Sensitises beta adrenoceptors to ambient levels of adrenaline and noradrenaline.
  2. Thus there is apparent sympathetic
    activation
    3.Tachycardia, palpitations, tremor in hands, lid lag
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5
Q

What are the symptoms of hyperthyroidism?

A
  1. Weight loss despite increased appetite
  2. Breathlessness,
  3. Palpitations, tachycardia
  4. Sweating
  5. Heat intolerance
  6. Diarrhoea
  7. Lid lag and other sympathetic features
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6
Q

What are the symptoms of

a thyroid storm?

A
  1. Hyperpyrexia > 41oC
  2. Accelerated tachycardia / arrhythmia
  3. Cardiac failure
  4. Delirium / frank psychosis
  5. Hepatocellular dysfunction; jaundice
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7
Q

What are the treatment options for hyperthyroidism?

A
  1. Thyroidectomy
  2. Radioiodine
  3. Drugs
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8
Q

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

A
  1. Thionamides (thiourylenes; anti-thyroid drugs)
  2. Potassium Iodide
  3. Radioiodine
  4. β-blockers
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9
Q

What thionamides are used in the treatment of hyperthyroidism?

A
  1. Propylthiouracil (PTU)

2. Carbimazole (CBZ)

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10
Q

What do the drugs for hyperthyroidism do?

A
  • First 3 drugs reduce thyroid hormone synthesis

- β-blockers help with symptoms

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11
Q

What drug class helps with hyperthyroidism symptoms?

A

β-blockers

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12
Q

What is the mechanism of action of thionamides?

A

Inhibition of thyroid peroxidase

And hence T3/4 synthesis and secretion

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13
Q

What are the unwanted actions of thionamides?

A
  1. Agranulocytosis (rare)

2. Rashes (relatively common)

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14
Q

What is the role of b blockers in thyrotoxicosis?

A

Takes several weeks for ATDs (anti-thyroid drugs) to have clinical effects eg reduced tremor, slower heart rate, less anxiety.
NON-selective (ie b1 & b2) b blocker eg propranolol achieves these effects in the interim.

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15
Q

When is iodide, usually KI, used?

A
  1. Preparation of hyperthyroid patients for surgery

2. Severe thyrotoxic crisis (thyroid storm)

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16
Q

What is the mechanism of action of KI?

A
  1. Inhibits iodination of thyroglobin

2. Inhibits hydrogen peroxide generation and thyoperoxidase

17
Q

What is the effects of KI?

A
  1. Inhibition of thyroid hormone synthesis & secretion
  2. WOLFF–CHAIKOFF effect - presumed autoregulatory effect
  3. Hyperthyroid symptoms reduce within 1-2 days
  4. Vascularity and size of gland reduce within 10-14 days
18
Q

What the risks associated with a thyroidectomy?

A
  1. Risk of voice change
  2. Risk of also losing parathyroid glands
  3. Scar
  4. Anaesthetic
19
Q

When is radioiodine contraindicated?

A

Pregnanacy

20
Q

What symptoms are seen in Viral (de Quervain’s) thyroiditis?

A
  1. Painful dysphagia
  2. Hyperthyroidism
  3. Pyrexia
  4. Thyroid inflammation
21
Q

Is there any iodine uptake in Viral (de Quervain’s) thyroiditis?

A

No

22
Q

Why is there no iodine uptake in Viral (de Quervain’s) thyroiditis?

A
  1. Virus attacks thyroid gland causing pain and tenderness
  2. Thyroid stops making thyroxine and makes viruses instead
  3. Thus no iodine uptake
23
Q

When does a viral thyroiditis become hypothyroid?

A
  1. Radioiodine uptake zero
  2. Stored thyroxine released
  3. Thus toxic with zero uptake
  4. Four weeks later, stored thyroxine exhausted, so hypothyroid.
24
Q

When does a viral thyroiditis become euthyroid again?

A

After a further month, resolution occurs (like in all viral diseases).

25
Q

What is a symptom of Viral (de Quervain’s) thyroiditis?

A

Neck becomes painful

26
Q

What is Postpartum thyroiditis?

A

Similar to Viral (de Quervain’s) thyroiditis but no pain and only occurs after pregnancy

Y2 BRS Endocrinology (9 decks)

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