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Finals: Medicine > Hyperthyroidism > Flashcards

Hyperthyroidism Flashcards

1
Q

Define hyperthyroidism

A

Caused by an overactive thyroid gland causing an excess of thyroid hormone (T3 and T4)

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2
Q

Hyperthyroidism is most commonly affects which gender?

A

Women

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3
Q

Define thyrotoxicosis

A

Refers to an excess of thyroid hormone, having an overactive thyroid gland is not a prerequisite (e.g. consumption of thyroid hormone)

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4
Q

Name three primary causes of hyperthyroidism

A

Primary meaning it is caused by thyroid dysfunction

  1. Graves’ disease
  2. Toxic multinodular goitre
  3. Radiation
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5
Q

Name two secondary causes of hyperthyroidism

A

Secondary meaning it is not caused by thyroid dysfunction

  1. Drugs e.g. Lithium
  2. Gestational hyperthyroidism
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6
Q

What is the most common cause of hyperthyroidism

A

Graves’ disease

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7
Q

Describe the pathogenesis of Graves Disease

A

Caused by IgG antibodies to the TSH receptors found within the thyroid – known as TSHR-Ab

TSHR-Ab mimic the action of TSH causing excessive stimulation of the gland

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8
Q

What is the second most common cause of hyperthyroidism

A

Toxic multinodular goitre

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9
Q

Describe the pathogenesis of toxic multinodular goitre

A

Characterised by multiple nodules that develop on the thyroid gland develop that are capable of secreting thyroid hormone

Acts independently of feedback system and therefore results in the continuous production of excessive thyroid hormone

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10
Q

Name some of the symptoms of hyperthyroidism

A

Goitre

Palpitations

Heat intolerance

Weight loss

Diarrhoea

Amenorrhoea

Reduced libido

Gynaecomastia (in men)

Fatigue

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11
Q

Name some of the signs of hyperthyroidism

A
  • Goitre
  • Sinus tachycardia/arrhythmias
  • Hair loss
  • Palmar erythema
  • Tremor
  • Thyroid bruit (Graves’)
  • Myxoedema - deposition of mucopolysaccharides in the skin leading to swelling.
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12
Q

What is the other name given to thyroid storm

A

Thyrotoxic crisis

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13
Q

Define thyroid storm

A

Hypermetabolic state induced by excessive release of thyroid hormones

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14
Q

What are the triad of symptoms for thyroid storm

A

High blood pressure

High temperature

Tachycardia

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15
Q

How is the thyroid storm managed

A

Symptom control with IV propranolol

Reduced thyroid activity with PPU

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16
Q

Why is PPU the preferred treatment for thyroid storm

A

Preferred as it inhibits peripheral thyroxine conversion

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17
Q

What are the three unique features associated with Graves Disease

A

Diffuse goitre (without nodules)

Graves’ ophthalmopathy

Pretibial myxoedema

Features caused by the presence of TSH receptor antibodies

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18
Q

Describe the pathogenesis of pretibial myxoedema

A

Infiltrative dermopathy resulting from deposition of mucin in the dermis on the anterior aspects of the leg (pre-tibial area)

19
Q

What are the biochemistry results for primary hyperthyroidism

A

Low TSH

High fT4 + fT3

20
Q

What are the biochemistry results for subclinical hyperthyroidism

A

Low TSH

Normal T3/4

21
Q

What are the biochemistry results for pituitary adenoma

A

High TSH

High T3/4

22
Q

What is the autoantibodies associated with Graves Disease

A

Thyroid stimulating hormone receptor antibodies (TSHR-Ab)

23
Q

What are the two imaging techniques used to investigate the thyroid

A

Ultrasonography

Thyroid uptake scan

24
Q

Name the three components of hyperthyroidism management

A
  • Medical therapy
    • Anti-thyroid drugs (thioamides)
    • Symptom relief
  • Radio-iodine
  • Surgery
25
Q

What is the first line anti-thyroid drugs (thioamides)

A

Carbimazole

26
Q

What are the names of the two types of anti-thyroid drugs

A

Carbimazole

Propylthiouracil (PPU)

27
Q

What is the second line anti-thyroid drug used in managing hyperthyroidism

A

Propylthiouracil (PPU)

28
Q

When is Propylthiouracil (PPU) the first line anti-thyroid drug?

A

Patient is intolerant to carbimazole

In first trimester of pregnancy

In thyroid storm

29
Q

What is a potential side effect of Propylthiouracil (PPU)

A

Small risk of severe hepatic reactions

30
Q

Name the two anti-thyroid drug regiments

A

Titration

Block and replace

31
Q

Describe the titration anti-thyroid drug regiment

A

Dose is carefully titrated to maintain normal levels of T3/T4

32
Q

Describe the block and replace anti-thyroid drug regiment

A

Carbimazole is given at a level sufficient to block endogenous T3/T4 production and the patient takes levothyroxine titrated to effect

33
Q

What drug is used in symptom relief in hyperthyroidism

A

Propranolol (non-selective beta blocker)

Blocks the adrenalin related symptoms of hyperthyroidism

34
Q

Why does the beta blocker used in the symptom relief of hyperthyroidism have to be non-selective

A

Non-selective beta blockers because they block adrenergic activity as opposed to more “selective” beta blockers that work only on the heart

35
Q

Radio-iodine is offered first line in what patient groups?

[Hyperthyroidism]

A

Graves’ disease in those suitable and not likely to enter remission

Toxic multinodular goitre

36
Q

How does radio-iodine work as a treatment for hyperthyroidism

A

Involves drinking a single dose of radioactive iodine – the iodine is taken up by the thyroid gland and the emitted radiation destroys a proportion of the thyroid cells reducing the thyroid hormone production

37
Q

Name a side effect of radio-iodine

A

Hypothyroidism requiring levothyroxine replacement

38
Q

When is radio-iodine contraindicated

A

Contraindicated in Graves eye disease because it may worsen symptoms

39
Q

Name three potential complications of thyroidectomy

A

Hypocalcaemia - due to the proximity of parathyroid gland to the thyroid gland.

Recurrent laryngeal nerve injury

Hypothyroidism

40
Q

Name some complications of hyperthyroidism

A

Thyroid storm (often precipitated by surgery, trauma or infection)

Atrial fibrillation

High output heart failure

Osteopenia/osteoporosis

Upper airway obstruction due to a large goitre

Corneal ulcers/visual loss in Graves’ eye disease

41
Q

Thyrotoxicosis without hyperthyroidism does not feature overactivity of the thyroid gland.

Name two conditions can cause thyrotoxicosis without hyperthyroidism

A

Thyroiditis: inflammation of the thyroid gland resulting in the release of stored thyroid hormone.

Exogenous ingestion: a person ingests thyroid hormone.

42
Q

What is De Quervain’s (subacute granulomatous) thyroiditis

A

Hyperthyroidism following a viral infection

Results in inflammation of the thyroid gland and release of thyroid hormone

Self-limiting - resolves on its own

43
Q

Name the characteristic feature of De Quervain’s thyroiditis

A

characteristically causes a painful goitre

Finals: Medicine (91 decks)

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