Hyperthyroidism

Question 1

secondary hyperthyroidism is due to?

Answer 1

excess stimulation by TSH

Question 2

graves disease

Answer 2

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

Question 3

what is plummer’s disease?

Answer 3

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

Question 4

exopthalmos?

Answer 4

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

Question 5

pretibial myxoedema?

Answer 5

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

Question 5

pretibial myxoedema?

Answer 5

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

Question 6

features of hyperthyroidism?

Answer 6

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

Question 7

graves disease features?

Answer 7

diffuse goitre no nodules
exopthalmos
pretibial myxoedema

Question 8

toxic multinodular goitre features?

Answer 8

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

Question 9

solitary toxic thyroid nodule?

Answer 9

benign adenoma, treated with surgery

Question 10

de quervain’s thyroidits features?

Answer 10

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

Question 11

what is special about de quervain’s thyroiditis?

Answer 11

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

Question 11

what is special about de quervain’s thyroiditis?

Answer 11

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

Question 12

treatment of de quervain’s thyroiditis?

Answer 12

supportive self limiting, NSAIDs and beta blockers for symptomatic relief

Question 13

thyroid storm?

Answer 13

acute severe hyperthyroidism causing pyrexia, tachycardia and delerium

Question 14

thyroid storm treatment?

Answer 14

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

Question 14

side effect of propythiouracil?

Answer 14

small risk hepatic reactions- death

Question 15

management of hyperthyroidism?

Answer 15

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

Question 16

side effect of carbimazole?

Answer 16

acute pancreatitis

Question 17

carbimazole and propylthiouracil can both cause?

Answer 17

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

Question 18

radioactive iodine remission can take?

Answer 18

6 months, may require levothyroxine

Question 19

rules of radioactive thyroxine?

Answer 19

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

Question 20

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

Answer 20

propanolol

Question 21

what is definitive option for thyroid storm?

Answer 21

thyroidectomy, patient will require levothyroxine after

Question 22

causes of thyrotoxicosis?

Answer 22

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)

Question 23

what do you find in thyrotoxicosis?

Answer 23

TSH down, T3/4 up thyroid autoantibodies isotope scanning

Question 24

De Quervain's thyroiditis ?

Answer 24

hyperthyroidism following viral infection

Question 25

4 phases of subacute thyroiditis?

Answer 25

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

Question 26

investigation for subacute thyroiditis?

Answer 26

thyroid scintigraphy (globally reduced uptake of iodine 131)

Question 27

treatment of de quervains thyroiditis?

Answer 27

NSAIDs, steroids if severe

Question 28

thyroid eye disease affects what percent of people with graves?

Answer 28

25-50%

Question 29

pathophysiology of thyroid eye disease?

Answer 29

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

Question 30

prevention of thyroid eye disease?

Answer 30

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

Question 31

features of thyroid eye disease?

Answer 31

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

Question 32

management of thyroid eye disease?

Answer 32

topical lubricant prevent corneal inflammation steroids radiotherapy surgery

Question 33

urgent referral to opthalmologist witht hyroid eye disease if?

Answer 33

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

Question 34

thyroid storm is not usually seen in?

Answer 34

iatrogenic thyroxine excess

Question 35

precipitating events of thyroid storm?

Answer 35

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

Question 36

clinical features of thyroid storm?

Answer 36

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

Question 37

management of thyroid storm?

Answer 37

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

Question 38

sick euthyroid syndrome?

Answer 38

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

Question 39

carbimazole?

Answer 39

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

Question 40

mechanism of action for carbimazole?

Answer 40

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

Question 41

what is mechanism of action of propylthiouracil?

Answer 41

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

Question 42

adverse effects of carbimazole?

Answer 42

agranulocytosis crosses placenta

Question 43

What is pretibial myxoedema due to?

Answer 43

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