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endocrine > Hyperthyroidism > Flashcards

Hyperthyroidism Flashcards

1
Q

what is the normal range of TSH?

A

0.3 - 4.5 mU/L

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2
Q

what is the normal range of free T4?

A

9 - 22 pmol/L

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3
Q

what is the active thyroid hormone?

A

T3

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4
Q

what treatment can be used prior to an anti-thyroid drug to control symptoms?

A

beta blockers (mainly propranolol)

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5
Q

what is the most serious side-effect of carbimazole?

A

agranulocytosis

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6
Q

what are some potential causes of a thyroid crisis?

A

acute stressors - trauma, surgery, infection

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7
Q

what are the clinical features of thyroid crisis (storm)?

A
  • marked hyperthyroid symptoms
  • multi-system compensations (e.g. jaundice, pulmonary oedema, confusion, agitation)
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8
Q

what is the management of thyroid crisis?

A
  • supportive management in high dependency unit
  • high dose anti-thyroid medication - IV propylthiouracil
  • potassium iodide (to inhibit hormone release from the gland)
  • cardiac glycoside - IV digoxin
  • beta blockers - IV propranolol
  • high dose steroids - prednisolone/hydrocortisone
  • plasmapheresis if unresponsive to treatment
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9
Q

what is the role of high dose steroids in thyroid crisis?

A

block the conversion of T4 to T3

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10
Q

what is subacute (de quervain’s) thyroiditis?

A

hyperthyroidism followed by hypothyroid phase due to depletion of thyroid hormone from the thyroid gland

hyperthyroidism -> hypothyroidism

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11
Q

what are the clinical signs of subacute (de quervain’s) thyroiditis?

A
  • hyperthyroidism
  • painful goitre
  • malaise
  • biochemistry in the early stages consistent with hyperthyroidism
  • raised CRP and ESR
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12
Q

what is the management of subacute (de quervain’s) thyroiditis?

A
  • NSAIDs + beta blockers
  • do not required anti-thyroid medications
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13
Q

when does subacute (de quervain’s) thyroiditis resolve?

A

self-limiting within 6 months - may be some residual hypothyroidism

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14
Q

what symptoms would indicate the need to commence anti-thyroid medication?

A

atrial fibrillation

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15
Q

what are the symptoms specific to graves disease?

A
  • exophthalmos
  • periorbital oedema
  • ophthalmoplediga
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16
Q

what is the normal range of total T4?

A

60 - 150 nmol/L

17
Q

what medication is used to manage women in pregnancy with hyperthyroidism?

A

propylthiouracil

18
Q

how does propylthiouracil work?

A

inhibits the thryoperoxidase enzyme which is involved in preparing iodine coupling with thyroglobulin

19
Q

what are the antibiodies found in graves disease?

A
  • TSH-receptor antibodies (found in 90% of graves)
  • anti-thyroid peroxidase antibodies (found in 75% of graves)
20
Q

what is postpartum thyroiditis?

A
  • condition occuring in women with autoimmune disease
  • hyperthyroid phase in the first 3 months post-pregnancy and then hypothyroid phase
21
Q

what is the management of post-partum thyroiditis?

A
  • watch and wait
  • 30% of patients require levothyroxine for 6-12 months
22
Q

biochemical findings in primary hypothyroidism

A

TSH low + T3 high + T4 high

23
Q

biochemical findings in secondary hyperthyroidism

A

TSH high + T3 high + T4 high

24
Q

biochemical findings in subclinical hyperthyroidism

A

TSH low + T3 normal + T4 normal

25
Q

what are the clinical features of hyperthyroidism?

A
  • fine tremor
  • finger clubbing
  • sweating
  • pretibital myxoedema
  • goitre
  • thyroid bruit
  • lid retraction
  • lid lag
  • atrial fibrillation
  • high output heart failure
  • diarrhoea
  • muscle wasting
  • proximal weakness
26
Q

what are the primary causes of hyperthyroidism?

A
  • graves disease
  • toxic thyroid adenoma
  • multinodular goitre
  • silent thyroiditis
  • de quervain’s thyroiditis
  • radiation
27
Q

what are the secondary causes of hyperthyroidism?

A
  • amiodarone
  • lithium
  • TSH producing pituitary adenoma
  • choriocarcinoma (beta-hCG can activate TSH receptors)
  • gestational hyperthyroidism
  • pituitary resistance to thyroxine (i.e. failure of negative feedback)
  • struma ovarii (ectopic thyroid tissue in ovarian tumours)
28
Q

what are the complications of hyperthyroidism?

A
  • thyroid storm
  • atrial fibrillation
  • high output heart failure
  • osteopenia/osteoporosis
  • upper airway obstruction due to a large goitre
  • corneal ulcers/visual loss in graves eye disease
29
Q

what should you screen for if there are signs of lack of compliance?

A

malabsorption - e.g. coeliac disease

30
Q

what features make grave’s disease more moderate and severe?

A
  • lid retraction >2mm
  • significant soft tissue involvement
  • exopthalamos >3mm
  • diplopia
  • optic neuropathy
  • corneal breakdown

endocrine (13 decks)

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