Hyperthyroidism Flashcards
What is the genetic association with hyperthyroidism
HLA-B8
HLA-DR2
HLA-DR3
What is the most common cause of hyperthyroidism
Grave’s
What are the primary causes of Hyperthyroidism (caused by thyroid dysfunction)
Grave's Toxic Adenoma Multinodular Goitre (secrete Thyroid) Silent Thyroiditis De Quervain's Thyroiditis(Painful) Radiation
What are the secondary causes of hyperthyroidism (No thyroid dysfunction)
Amiadorone (Used for AF) Lithium TSH producing pituitary adenoma Choriocarcinoma (Beta HCG activates TSH) Gestational
What are the peripheral features of Hyperthyroidism
Fine tremor
Clubbing
Sweating
Pretibial myxoedema
What is Pretibial Myxoedema
excess glycosaminoglycans under the skin
What neck features can be seen typically
Goitre (neck swelling) Thyroid bruit (sound heard over the thyroid)
What cardiac features are seen in Hyperthyroidism
Atrial fibrillation
Heart fail
What is a symptom relief of hyperthyroidism
Propranolol (beta blocker)
What medicine is used in hyperthyroidism
Carbimazole w/propanolol
Propylthiouracil (thyroid strom)
Pregnancy contraindications of carbimazole and propylthiourail
propylthiouracil - use in first trimester
Carbimazole - use in 2nd and 3rd
When should you use radio-iodine therapy
In multinodular goitre and adenoma
Avoid with Graves
When should you use thyroidectomy
Recurrence
Goitres
Potential Cancer
What are some complications of thyroidectomy
Hypoparathyroidism
Hypocalcemia
Laryngeal nerve damage
bleeding
How do you manage a thyroid storm
1st = Propylthiouracil with KI
Prednisolone/Propanolol/Digoxin
What aggravates a Thyroid storm (fever, tachycardia, confusion and N+V)
Surgery
Trauma
Infection
What are complications of Hyperthyroidism
Thyroid storm Atrial fibrillation Heart fail Goitre = Airway obstruction Grave's Eye diseases
What are some features seen with Grave’s eye
Exopthalmus (eye bulge)
Periorbital oedema (eye swelling)
Opthalmoplegia (extraocular paralysis)
What kind of goitre is seen in Grave’s
Smooth symmetrical painless goitre
What are the causes of a smooth goitre
Graves Hashimotos Drugs( Lithium and amiadorone) Iodine (high and low) De Quervain's (Painful) Infitration (sarcoidosis and Haemochromotosis)
What are the causes of a Nodular Goitre
Non functional Thyroid Adenoma
Multinodular Goitre
Thyroid cyst
Cancer
What are the investigations for Hyperthyroidism
Thyroid function test = High T3 AND T4
Beta-hCG = high (use US to find mass)
MRI = Pituitary adenoma?
What are the changes between primary and secondary and tertiary TSH, T3 and T4 levels
TSH-T3-T4
P = LOW-HIGH-HIGH
S = ALL HIGH
What is the action of Carbimazole
Inhibits thyroid peroxidase enzyme
What are some side effects of carbimazole
rash
pruritus
Agranulocytosis with neutropenia
Where is the thyroid found
C5-T1 Connected w/Isthmus
What two arteries supply the thyroid
Inferior Thyroid artery (From Subclavian)
Superior Thyroid artery (From ECA)
How is T1 and T2 produced
Iodine enters colloid
Iodine binds to Tyrosine on Thyroglobulin(by TPO enzyme)
TSH to receptor binding = T1 and T4
How is T3 and T4 produced
T1 + T2 = T3
T2 + T2 = T4
They move in circulation
What is the pathology of Hyperthyroidism
TSH-R autoantibodies = Increase Thyroid stimulation
What can be given if Carbimazole is CI
Propylthiouracil
What is the block and reduce method in treating Hyperthyroidism for pregnant women
Give antithyroid drug
Give Levothyroxine to prevent HYPOTHYROIDSIM
