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Endocrinology > Hyperthyroidism > Flashcards

Hyperthyroidism Flashcards

1
Q

secondary hyperthyroidism is due to?

A

excess stimulation by TSH

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2
Q

graves disease

A

autoimmune disease, TSH receptor antibodies, mimic TSH and cause secretion of thyroid hormone- most common cause

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3
Q

what is plummer’s disease?

A

toxic multinodular goitre, nodules act independently from feedback system and continuously produce thyroid hormone

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4
Q

exopthalmos?

A

bulging of eyeball due to Graves, inflammation swelling and hypertrophy of tissues behind eyeball

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5
Q

pretibial myxoedema?

A

deposits of mucin under skin on legs- discoloured waxy oedematous. Graves- reaction of tissues to the TSH receptor antibodies

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5
Q

pretibial myxoedema?

A

deposits of mucin under skin on legs- discoloured waxy oedematous. Graves- reaction of tissues to the TSH receptor antibodies

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6
Q

features of hyperthyroidism?

A

anxiety irritability, sweating, heat intolerance, fatigue, tachycardia, weight loss, frequent loose stools, sexual dysfunction, palpitations, high output cardiac failure, thyroid acropathy (extremities), clubbing, oligomenorrhoea, diarrhoea

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7
Q

graves disease features?

A

diffuse goitre no nodules
exopthalmos
pretibial myxoedema

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8
Q

toxic multinodular goitre features?

A

goitre with firm nodules
> over 50 years
second most common cause of thyrotoxicosis

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9
Q

solitary toxic thyroid nodule?

A

benign adenoma, treated with surgery

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10
Q

de quervain’s thyroidits features?

A

hyperparathyroidism, viral infection, fever, dysphagia, neck pain and tenderness

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11
Q

what is special about de quervain’s thyroiditis?

A

hyperthyroid phase followed by hypothyroid phase (TSH fall due negative feedback) then back to normal

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11
Q

what is special about de quervain’s thyroiditis?

A

hyperthyroid phase followed by hypothyroid phase (TSH fall due negative feedback) then back to normal

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12
Q

treatment of de quervain’s thyroiditis?

A

supportive self limiting, NSAIDs and beta blockers for symptomatic relief

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13
Q

thyroid storm?

A

acute severe hyperthyroidism causing pyrexia, tachycardia and delerium

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14
Q

thyroid storm treatment?

A

admit, supportive care: fluid, anti-arrhythmic drugs and beta blockers

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14
Q

side effect of propythiouracil?

A

small risk hepatic reactions- death

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15
Q

management of hyperthyroidism?

A

carbimazole 12-18months. Usually 4/8 weeks maintenance normal levels titration block or block all production and then replace levothyroxine

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16
Q

side effect of carbimazole?

A

acute pancreatitis

17
Q

carbimazole and propylthiouracil can both cause?

A

agranulocytosis (low white cell count) which makes patient vulnerable to severe infection- (sore throat)

18
Q

radioactive iodine remission can take?

A

6 months, may require levothyroxine

19
Q

rules of radioactive thyroxine?

A

not get pregnant and breastfeed within 6 months of treatment
men should not father children within 4 months of treatment
limit contact with people after dose 3 weeks

20
Q

what should be given for hyperthyroidism for adrenalin-related symtoms?

A

propanolol

21
Q

what is definitive option for thyroid storm?

A

thyroidectomy, patient will require levothyroxine after

22
Q

causes of thyrotoxicosis?

A

Graves’ disease
toxic nodular goitre
acute phase of subacute (de Quervain’s) thyroiditis
acute phase of post-partum thyroiditis
acute phase of Hashimoto’s thyroiditis (later results in hypothyroidism)
amiodarone therapy
contrast (elderly patients with existing thyroid disease)

23
Q

what do you find in thyrotoxicosis?

A

TSH down, T3/4 up
thyroid autoantibodies
isotope scanning

24
Q

De Quervain’s thyroiditis ?

A

hyperthyroidism following viral infection

25
Q

4 phases of subacute thyroiditis?

A
  1. 3-4 weeks hyperthyroidism, painful goitre raised ESR
  2. 1-3 weeks euthyroid
  3. weeks-months hypothyroidism
  4. thyroid structure and function goes back to normal
26
Q

investigation for subacute thyroiditis?

A

thyroid scintigraphy (globally reduced uptake of iodine 131)

27
Q

treatment of de quervains thyroiditis?

A

NSAIDs, steroids if severe

28
Q

thyroid eye disease affects what percent of people with graves?

A

25-50%

29
Q

pathophysiology of thyroid eye disease?

A

autoimmune response against an autoantigen, TSH receptor to retro-orbital inflammation. inflammation results in glycosaminoglycan and collagen deposition in the muscles

30
Q

prevention of thyroid eye disease?

A

smoking is a risk factor
radioiodine treatment may increase inflammatory symptoms , prednisolone may help reduce the risk

31
Q

features of thyroid eye disease?

A

eu-hypo, hyperthyroid
exopthalmos
optic disc swelling
opthalmoplegia
conjunctival oedema
sore, dry eyes, because cant close
keratopathy

32
Q

management of thyroid eye disease?

A

topical lubricant prevent corneal inflammation
steroids
radiotherapy
surgery

33
Q

urgent referral to opthalmologist witht hyroid eye disease if?

A

unexplained deterioration in vision
awareness of change in intensity/quality of colour vision
history of eye suddenly popping out
obvious corneal opacity
cornea still visible when eyelids are closed
disc swelling

34
Q

thyroid storm is not usually seen in?

A

iatrogenic thyroxine excess

35
Q

precipitating events of thyroid storm?

A

thyroid/non thyroid surgery
trauma
infection
acute iodine load CT contrast media

36
Q

clinical features of thyroid storm?

A

fever over 38.5
tachycardia
hypertension
heart failure
n/v
abdnormal LFTs, jaundice
confusion and agitation

37
Q

management of thyroid storm?

A

symtomatic- paracetamol
treatment of underlying event
beta blockers - iv propanolol
anti thyroid drugs- methimazole, propylthiouracil
lugol’s iodine
dexamethasone- 4mg IV qds- blockks conversion of t4 to t3

38
Q

sick euthyroid syndrome?

A

TSH,T3 or T4 low or TSH may be within normal range.
no treatment is needed ad changes are reversible on recovery

39
Q

carbimazole?

A

Used for thyrotoxicosis. High doses for 6 weeks until patient is euthyroid then reduced.

40
Q

mechanism of action for carbimazole?

A

blocks thyroid peroxidase from coupling and iodinating tyrosine residues on thyroglobulin hence reducing thyroid hormone production.

41
Q

what is mechanism of action of propylthiouracil?

A

blocks thyroid peroxidase from coupling and iodinating the tyrosine residue on thyroglobulin and hence reduced thyroid hormone production.

ALSO inhibits 5’ deiodinase which reduced peripheral conversion of T4 to T3

42
Q

adverse effects of carbimazole?

A

agranulocytosis
crosses placenta

43
Q

What is pretibial myxoedema due to?

A

accumulation of excess glycosaminoglycans in the dermis and subcutis of the skin. The main glycosaminoglycans hyaluronic acid made by fibroblasts

Endocrinology (13 decks)

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