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Y2 ENDOCRINOLOGY > Hyperthyroidism > Flashcards

Hyperthyroidism Flashcards

1
Q

Outline the function of a thyroid follicular cell

A

Anterior pituitary releases TSH which activates iodide uptake. TSH also activates proteolytic enzymes causing release of T3 and T4

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2
Q

What are the general symptoms of hyperthyroidism?

A

Weight loss despite increased appetite, breathlessness, palpitations, tachycardia, tremor, increased sweating, diarrhoea, lid lag and heat intolerance

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3
Q

What are the 4 main causes of hyperthyroidism?

A

Graves’ disease.
Plummers disease - toxic solitary nodule or multinodular.
Viral thyroiditis
Post-natal thyroiditis

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4
Q

Outline the pathophysiology of Graves’ disease and what specific symptoms this causes

A

Autoimmune disease where antibodies bind to and stimulate the TSH receptor in the thyroid. Causes smooth goitre, exopthalmos and pretibial myxoedema

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5
Q

What is seen in the thyroid scan of a patient with Graves’ disease

A

Uniform uptake

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6
Q

Outline the differences seen in blood hormone levels between primary and secondary hyperthyroidism

A

Primary = low T3/T4, high TSH
Secondary = low T3/T4, low TSH

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7
Q

Outline the actions of thyroid hormone

A

Essential for foetal growth and development. Increases basal metabolic rate and cardiac output

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8
Q

Outline the pathophysiology of Plummers disease

A

Toxic nodular goitre, not autoimmune but due to benign adenoma that is overactive

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9
Q

What difference in symptoms are there between Plummers disease and Graves’ disease?

A

In Plummers no pretibial myxoedema or exophthalmos, unilaterally large goitre

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10
Q

What does the pituitary gland of a patient with Plummers disease look like?

A

Unilateral lump, rest of gland atrophies

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11
Q

What would a radioiodine uptake test look like in a patient with Plummers disease

A

A single or multiple hot nodules

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12
Q

Outline the effects of thyroxine on the sympathetic nervous system

A

T3 makes beta adrenoreceptors sensitive to ambient levels of adrenaline and noradrenaline. This causes tachycardia, palpitations, tremor and lid lag

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13
Q

What is thyroid storm and what are the symptoms

A

Thyroid storm results from hyperthyroidism being left untreated. It is a medical emergency with 50% mortality rate. Is blood result confirmed hyperthyroidism plus: hyperpyrexia, tachycardia, cardiac failure, delirium, jaundice. Needs aggressive treatment.

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14
Q

What are the treatment options for hyperythyroidism?

A

Thyroidectomy, radioiodine, drugs

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15
Q

What drugs are used to treat hyperthyroidism?

A

Thionamides (PTU and CBZ). Potassium iodide. Radioiodine and non-selective B-blockers

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16
Q

What is the benefit of non-selective beta-blockers being used to treat hyperthyroidism?

A

Help stop tremors aswell as tachycardia

17
Q

Outline the mechanism of action of thionamides

A

Inhibit thyroid peroxidase and hence T3/T4 secretion. Has instant biochemical effects but physical effect can take a month as T4 hormones already stored

18
Q

What are the adverse effects of thionamides?

A

Agranulocytosis - suppression of the immune system, can lead to sepsis and rashes, reversable.

19
Q

Outline the risks associated with a. Thyroidectomy

A

Risk of voice change - recurrent laryngeal nerve lesion. Risk of losing parathyroid glands

20
Q

Outline the 6 steps of thyroid hormone synthesis

A

TSH binds to receptors causing TG production and TPO activation - transported into the colloid.
Iodide ions diffuse into colloid.
TPO oxidises I- into I2
TPO attaches I2 into tyrosine residues on the thyroglobulin producing MIT and DIT.
Iodinated tyrosines link together forming thyroid hormones.
Lysosomal enzymes remove thyroglobulin from thyroid hormones

21
Q

What are the clinical uses of potassium iodide?

A

Preparation of hyperthyroid patients for surgery.
Severe thyrotoxic crisis (thyroid storm)
Should only be used temporarily (10 days)

22
Q

What precautions need to be put in place for radioiodine treatment?

A

is contraindicted in pregnancy, have to avoid children and pregnant women for 7 days due to radiation

23
Q

Outline the pathophysiology of viral thyroiditis

A

virus attacks follicular thyroid gland causing pain. No iodine uptake causing all stored thyroxine to be released. Free T4 levels rise, TSH drops for a month of hyperthyroidism. FT4 falls and patient becomes hypothyroid, body recovers naturally

24
Q

what are the key clinical features of viral thyroiditis?

A

painful dysphagia, hyperthyroidism, pyrexia, thyroid inflammation

25
Q

What TSH levels will you find in someone with primary hyperthyroidism?

A

High TSH

26
Q

what is pretibial myxoedema?

A

the swelling that occurs on the shins of patients with Graves disease, growth of soft tissue

27
Q

outline the mechanism of action of KI treatment

A

Inhibits iodination of thyroglobulin. Inhibits H2O2 generation and thyoperoxidase activity

28
Q

Following KI treatment how long does it take for hyperthyroid symptoms to reduce?

A

1-2 days

29
Q

following KI treatment for hyperthyroidism, how long does it take for the vascularity and the size of the gland to reduce?

A

10-14 days

30
Q

What is seen on a cellular level of a hyperplastic thyroid gland?

A

Acinar hyperplasia and loss of colloid

31
Q

what is seen overall, and on a cellular level of a hyperplastic thyroid gland following thiouracil?

A

Gland mass further increases. increase in acinar cell hyperplasia and complete loss of colloid

32
Q

what is seen overall, and on a cellular level of a hyperplastic thyroid gland following thiouracil and iodide?

A

Gland reduces in size. Involution of acinar epithelium, storage of iodine in a poor colloid

33
Q

What is seen in the thyroid scan of someone with viral thyroiditis?

A

no iodine uptake

Y2 ENDOCRINOLOGY (13 decks)

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