Hyperthyroidism Flashcards
another word for hyperthyroidism?
Thyrotoxicosis
Define thyrotoxicosis?
overactive thyroid gland
most common cause
Grave’s disease
is Grave’s a primary or secondary problem?
primary
90% of grave’s will have what autoantibody?
TSH receptor antibodies
which gender effected most by hyperthyroidism?
females
When only T3 increased what is it called?
toxicosis
really high thyroid hormone causes what emergency?
Thyroid Storm
explain pathophys of grave’s?
Anti-TSH antibodies stimulate TSH receptor on thyroid gland > ↑thyroid hormone
how does grave’s cause a goitre?
step by step
Anti-TSH antibodies > hit TSH receptor on thyroid glands > iodine influx into thyroid gland > thyroid cell hyperplasia > goitre made
↑thyroid hormone will do what to meatbolism and SNS?
↑
how can pituitary adenoma cause a goitre?
↑TSH > iodine influx into thyroid gland > thyroid cell hyperplasia > goitre made
hyperthyroidism:
what happens to weight?
Lose weight
hyperthyroidism:
what happens to mood?
Anxiety
Irritability
hyperthyroidism:
main symptom at skin?
Sweaty
hyperthyroidism:
main gut symptom?
Diarrhoea
hyperthyroidism:
heart symptoms?
-2
Palpitations
Arrhythmias AF
hyperthyroidism:
symptom only women can get?
Oligomenorrhea
define oligomenorrhea?
very few or light periods
oligos meaning?
small
hyperthyroidism symptoms?
-9
Sweaty Lose weight Diarrhoea Irritability Anxiety Tremor Palpitations Arrhythmias AF Oligomenorrhea
grave’ specific symptoms at the face?
-2
Eyes – exophthalmos, ophthalmoplegia
eye symptoms when you have grave’s disease is called what?
thyroid eye disease
why you get thyroid eye disease in grave’s disease?
• Anti-TSH antibodies react with orbital antigen > thyroid eye disease
grave’ specific symptoms,
what triad of symptoms can you get?
what is this triad called?
clubbing, swollen hands and feet, new bone being made
Thyroid acropachy
graves’ dermopathy is aka what?
Pretibial myxedema
how does Pretibial myxedema look like on a pt?
swollen lower legs
Pituitary Adenoma can cause headaches.
why?
Pituitary adenoma stretches dura mater
Pituitary Adenoma can cause what visual field defect?
Bitemporal hemianopia
hyperthyroidism sign on neuro exam?
Hyperreflexia
hyperthyroidism of the eyes?
Lid Lag
pt has hyperthyroidism
1° thyroid problem will have what TFTs?
↑T4 ↑T3 ↓TSH
pt has hyperthyroidism
1° thyroid problem will have what TFTs?
↑T4 ↑T3 ↓TSH
pt has hyperthyroidism
2° thyroid problem will have what TFTs?
↑T4 ↑T3 ↑TSH =
↑T3 only is called what?
toxicosis
% wise how many hyperthyroidism are primary vs secondary?
99% are primary
define 1° thyroid problem?
problem at thryoid gland itself?
1° hyperthyroid problem.
TSH levels?
↓TSH
1° hyperthyroid problem.
T4 and T3 levels?
↑T4 ↑T3
2° hyperthyroid problem.
TSH levels?
↑TSH
in 1° hyperthyroid problem why is TSH low?
negative feedback
you do blood test for antibodies in pt with Graves.
main antibody in graves?
TSH receptor antibodies
you do blood test for antibodies in pt with Graves.
2nd most common antibody in graves?
how many will have this antibody?
Anti-thyroid peroxidase antibodies
70%
you do blood test for antibodies in pt with Graves.
3rd most common antibody in graves?
how many will have this antibody?
Anti-thyroglobulin
30%
Ix to look at iodine uptake in thyroid gland?
(what is it called?
Thyroid scintigraphy
Thyroid scintigraphy result in Grave’s?
diffuse uptake of I-
Ix to check for goitre compression?
CT/MRI
best Ix to check for thyroid cancer?
fine-needle biopsy
bets Ix to check for Pituitary adenoma problem in suspected secondary hyperthyroidism?
MRI brain
glucose levels in hyperthyroidism?
up or down
up
pt has hyperthyroidism.
why would you do ECG?
what are you looking for?
ECG
AF
pt has hyperthyroidism.
has mild symptoms,
drug given to stop tremor?
propranolol
pt has hyperthyroidism.
cause is Grave’s disease
main drug given?
-name
carbimazole
pt has Grave’s disease.
mainstay drug given?
-name
strength?
carbimazole
40mg
pt has Grave’s disease.
carbimazole not worked.
2nd line treatment?
radioiodine treatment
pt has Grave’s disease
radioiodine treatment not worked, still has symptoms.
3rd line treatment?
thyroidectomy
women is pregnant, has grave’s disease.
mainstay drugs given?
-2 (names)
Propylthiouracil in 1st trimester then switch to carbimazole
pt has Thyroid eye disease.
what do you give to treat these symptoms 1st line?
-group
topical lubricants
pt has Thyroid eye disease.
topical lubricants used, still has symptoms.
2nd line Mx?
- 2
- one is drug class
steroids or orbital radiation
pt has hyperthyroidism,
cause is thyroiditis.
1st Line Mx?
do nothing,
self-limiting ∴ treatment rarely needed
pt has hypothyroidism,
cause is pituitary adenoma.
main treatment?
radioiodine therapy
pt has hyperthyroidism,
cause is Goitre .
main treatment?
radioiodine therapy
outline 3 step Mx plan for Grave’s disease?
- Start carbimazole at 40 mg
- Reduce dose gradually to maintain euthyroidism
- Continue for 12-18 months
how many will relapse after the 3step Mx plan?
-% wise
50%
Carbimazole moa?
blocks thyroid peroxidase
blocking thyroid peroxidase does what exactly?
blocks iodination of thyroglobulin
Carbimazole main dangerous se?
agranulocytosis
Propylthiouracil moa?
blocks iodination of thyroglobulin
radioactive iodine is abbreviated to what?
I-131
Radioactive iodine therapy is contraindicated in what thyroid disease?
why?
thyroid eye disease
can make it worse
Thyroidectomy.
2 main risks?
risk of hypothyroidism
risk of recurrent laryngeal nerve palsy
Radioactive iodine therapy has what ironic long term complication?
what drug do you give to treat this?
hypothyroidism
levothyroxine
female is going to have radioactive iodine therapy.
what pt advice do you give her?
do not become pregnant for 6 months
how does I-131 help hyperthyroidism?
sticks to thyroid cancer cells or just thyroid cells,
then radiation will kill these cells
