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C. Year 3 MLA Reproductive and Endocrinology > Hyperthyroidism > Flashcards

Hyperthyroidism Flashcards

1
Q

Thyrotoxicosis = increased levels of thyroid hormones in circulation.
Hyperthyroidism = increased secretion of thyroid hormones from thyroid gland. Which is more serious?

A
  • thyrotoxicosis
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2
Q

The thyroid gland wraps around the cricoid cartilage. But which vertebrae does the thyroid gland align with?

1 - C1-C2
2 - C2-C3
3 - C5-T1
4 - T2-T4

A

3 - C5 -T1

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3
Q

Label the image below using these labels:

  • thyroid cartilage
  • cricoid cartilage
  • right lobe of thyroid gland
  • isthmus
  • left lobe of thyroid gland
  • trachea
A

1 - cricoid cartilage
2- right lobe of thyroid gland
3 - trachea
4 - isthmus
5 - left lobe of thyroid gland
6 - thyroid cartilage

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4
Q

In order for thyroid hormones triodothyronine (T3) and thyroxine (T4) to have an affect at tissue throughout the body there are 3 stages of the positive feedback loop. These are essentially the stages that result in T3 and T4 being secreted and reaching the target tissue. Which of the following is NOT one of these stages?

1 - hypothalamus signals the pituitary gland
2 - T3 and T4 in the blood signal only the hypothalamus as part of the negative feedback loop
3 - pituitary gland signals the thyroid gland
4 - triiodothyronine (T3) signalling in tissue and thyroxine (T4) signalling in the circulation

A

2 - T3 and T4 in the blood signal only the hypothalamus as part of the negative feedback loop

  • T3 and T4 signal both the hypothalamus and pituitary gland
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5
Q

There are 3 common thyroid tests that are conducted, namely thyroid stimulation hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4). What are the normal levels of TSH secretion?

1 - 0.3 - 3.5 mU/L
2 - 0.3 - 7.5 mU/L
3 - 1.3 - 5.5 mU/L
4 - 3.5 - 7.5 mU/L

A

1 - 0.3 - 3.5 mU/L

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6
Q

There are 3 common thyroid tests that are conducted, namely thyroid stimulation hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4). What are the normal levels of FT4 secretion?

1 - 1 - 2.5 pmol/L
2 - 1.5 - 2.5 pmol/L
3 - 10 - 25 pmol/L
4 - 100 - 250 pmol/L

A

3 - 10 - 25 pmol/L

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7
Q

There are 3 common thyroid tests that are conducted, namely thyroid stimulation hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4). What are the normal levels of FT3 secretion?

1 - 0.5 - 3.5 pmol/L
2 - 3.5 - 7.5 pmol/L
3 - 35 - 75 pmol/L
4 - 350 - 750 pmol/L

A

2 - 3.5 - 7.5 pmol/L

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8
Q

What is the prevalence of hyperthyroidism?

1 - 0.5%
2 - 5%
3 - 15%
4 - 50%

A

1 - 0.5%

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9
Q

Is hyperthyroidism more common in men or women?

A
  • women
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10
Q

What is the typical age of onset of hyperthyroidism?

1 - 15-30
2 - 20-40
3 - 30-50
4 - >65

A

2 - 20-40

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11
Q

Does a negative TSH receptor antibody (TRAb) and Thyroid peroxidase (TPO) test rule out thyroid pathology?

A
  • no
  • TPO and TSH auto-antibodies are intracellular making detection difficult
  • BUT a positive test does confirm a diagnosis, which can be for hypo and hyperthyroidism
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12
Q

Thyroid stimulating hormone (TSH) is released from the pituitary gland following stimulation from thyrotropin releasing hormone. What is the most common condition name of hyperthyroidism?

1 - Cushing disease
2 - Hashimoto thyroiditis
3 - Addison’s disease
4 - Graves disease

A

4 - Graves disease
- caused by antibodies (IgG) against TSH
- thyroid stimulating antibodies act like TSH and cause excessive T3 and T4 to be released

  • Graves disease accounts for 75% of hyperthyroidism
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13
Q

When measuring thyroid stimulating hormone (TSH) in a clinical setting, which 2 of the following are the main limitations?

1 - TSH is slow to respond due to pathological changes, so acute not the best measure
2 - T3 and T4 are poor markers for TSH
3 - TSH test assumes no pituitary pathology, so T3 and T4 need to be tested alongside
4 - measuring TSH in tissues is also require to confirm findings

A

1 - TSH is slow to respond due to pathological changes, so acute not the best measure

3 - TSH test assumes no pituitary pathology, so T3 and T4 need to be tested alongside

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14
Q

Hyperthyroidism results in an increased level of T3 and T4 thyroid hormones. Which of the following is NOT a common symptom patients can present with?

1 - unintentional weight loss (even if appetite and intake remains constant)
2 - bradycardia
3 - arrhythmia
4 - palpitations
5 - increased appetite
6 - nervousness, anxiety and irritability.

A

2 - bradycardia
- typically causes tachycardia

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15
Q

Hyperthyroidism results in an increased level of T3 and T4 thyroid hormones. Which of the following is NOT a common clinical sign of hyperthyroidism?

1 - tremor
2 - warm and moist skin
3 - tachycardia
4 - reduced reflexes
5 - eye signs
6 - thyroid bruit and goitre
7 - muscle weakness
8 - atrial fibrillation

A

4 - reduced reflexes
- typically causes brisk reflexes

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16
Q

gWhich of the following is NOT a complication of hyperthyroidism?

1 - heart failure (thyrotoxic cardiomyopathy)
2 - CKD
3 - AF
4 - angina
5 - osteoporosis
6 - gynaecomastia
7 - ophthalmopathy (thyroid eye disease)

A

2 - CKD

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17
Q

Of all the clinical signs patients with hyperthyroidism can present with, which 2 are only present in hyperthyroidism?

1 - thyroid eye disease
2 - pretibial myxoedema
3 - weight loss
4 - anxiety

A

1 - thyroid eye disease
2 - pretibial myxoedema

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18
Q

Patients with hypothyroidism can experience hypokalaemic periodic paralysis. Why is this?

1 - low K+ reduces resting membrane potential
2 - depolarisation is delayed as too much K+ inside the cell
3 - low plasma K+ means it is higher in cells, which can accentuate repolarisation and low resting membrane potential further
4 - all of the above

A

3 - low plasma K+ means it is higher in cells, which can accentuate repolarisation and low resting membrane potential further

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19
Q

Hyperthyroidism can cause thyroid eye disease (TED) also known as thyroid associated ophthalmopathy (TAO). Which of the following is NOT a sign of TED?

1 - inflammation of all orbital tissues except the eye (muscle, eyelids, conjunctiva)
2 - itchy dry eyes
3 - prominent eyes, called exophthalmos/proptosis
4 - reduced sympathetic tone causing eyes to appear more closed
5 - diplopia (double vision)

A

4 - reduced sympathetic tone causing eyes to appear more closed
- increased sympathetic tone is more common, causing the eyes to open more

  • patients also have build up of glycoproteins in the tissues around the eyes making them more difficult to close
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20
Q

Graves disease accounts for 75% of autoimmune caused hypethyroidism. Autoantibody (Ig) binds to the TSH receptor on the follicular thyroid epithelial cells, mimicking the stimulatory action of TSH, causing hyperthyroidism. Does this increase or decrease the size of the thyroid?

A
  • hypertrophy and hyperplasia of the thyroid gland
  • results in a goitre eventually
21
Q

In a patient with graves disease, which accounts for 75% of autoimmune caused hyperthyroidism. If we do a dadioiodine uptake test, the iodine will travel to the thyroid. Will we see more of less dadioiodine uptake in the thyroid of a patient with hyperthyroidism when compared to a healthy patient?

A
  • patient with hyperthyroidism will have high uptake of iodine to synthesis T3 and T4
  • thyroid will also be enlarged-
22
Q

What is toxic adenoma in relation to the thyroid?

1 - adenoma that has metastasised in the thyroid
2 - adenoma of the pituitary gland
3 - adenoma of the thyorid gland causing excessive T3 and T4
4 - all of the above

A
  • 3 - adenoma of the thyorid gland causing excessive T3 and T4
  • levels of T3 and T4 become toxic and damage tissues
23
Q

All of the following are causes of primary hyperthyroidism. Match the descriptions below with the following:

  • graves disease
  • toxic adenoma
  • multiple nodular goitre
  • individual nodule growth on thyroid
  • increased levels of T3 and T4 throughout thyroid
  • multiple nodular growths on thyroid
A
  • graves disease = increased levels of T3 and T4 throughout thyroid
  • toxic adenoma = individual nodule growth on thyroid
  • multiple nodular goitre = multiple nodular growths on thyroid
24
Q

Which of the following is the main cause of secondary hyperthyroidism?

1 - thyroid hyperplasia
2 - TSH secreting pituitary adenoma
3 - toxic adenoma
4 - singular thyroid nodule

A

2 - TSH secreting pituitary adenoma

25
Q

Thyroiditis is the inflammation of the thyroid gland. What is De Quervain’s thyroiditis?

1 - inflamed thyroid linked to adenoma
2 - subacute inflamation of the thyroid gland
3 - inflammation of the thyroid due to toixic levels of TSH
4 - inflammation of the thyroid and excessive T3 and T4 production

A
  • 2 - subacute inflamation of the thyroid gland
  • can cause painful swelling of the thyroid gland
  • has been linked with vital infections
26
Q

Thyroiditis is the inflammation of the thyroid gland. What is Postpartum thyroiditis and what causes this?

1 - inflamed thyroid linked to adenoma
2 - subacute inflamation of the thyroid gland
3 - inflammation of the thyroid due to toixic levels of TSH
4 - inflamed thyroid following birth linked with autoimmunity

A

4 - inflamed thyroid following birth linked with autoimmunity
- initially causes hyperthyroidism and then hypothyroidism

27
Q

Thyroiditis is the inflammation of the thyroid gland. Which acute infections can cause thyroiditis?

1 - viral
2 - bacterial
3 - parasitic
4 - all of the above

A

-2 - bacterial
- can be treated if you address the bacterial infection with antibiotics

28
Q

When trying to diagnose a patient with hyperthyroidism, which of the following is NOT routinely performed?

1 - autoantibody test (TSH, TPO)
2 - ECG
3 - TFTs and FBC
4 - X-ray
5 - thyroid uptake scan
6 - ultrasound of thyroid and neck

A

4 - X-ray

29
Q

If a patient presents with low levels of thyroid stimulating hormone (TSH) and high levels of thyroxine (T4) and triiodothyronine (T3), is this likely to be hyperthyroidism or hypothyroidism?

A
  • hyperthyroidism (primary)
  • high levels of T3 and T4 cause negative feedback on pituitary gland reducing TSH
  • despite low TSH there is still elevated T3 and T4
30
Q

If a patient presents with low levels of thyroid stimulating hormone (TSH) and high levels of thyroxine (T4) and triiodothyronine (T3) as measured through blood tests, this is likely to be primary hyperthyroidism rather than hypothyroidism. All of the following can cause hyperthyroidism, but which is the most common?

1 - TSH autoantibodies
2 - mutated TSH receptor from toxic nodular goitre
3 - hyper functioning thyroid adenoma
4 - inflammation or damage to the thyroid gland

A

1 - TSH autoantibodies
- causes graves disease
- TSH autoantibodies mimic TSH causing high levels of T3 and T4
- TSH would be low though due to negative feedback

31
Q

If a patient presents with low levels of thyroid stimulating hormone (TSH) and high levels of thyroxine (T4) and triiodothyronine (T3) as measured through blood tests, this is likely to be hyperthyroidism caused by Graves disease. Which test can be helpful in further substantiating a diagnosis of hyperthyroidism?

1 - MRI of the neck
2 - TFT levels
3 - ECG
4 - TSH Receptor Antibodies (TRAb)

A

4 - TSH Receptor Antibodies (TRAb)
- TPO auto antibodies should also be tested

32
Q

A bruit is an abnormal sound generated by turbulent flow of blood in an artery due to either an area of partial obstruction. Why might we hear this in a patient with hyperthyroidism?

1 - enlarged thyroid requires increased blood supply
2 - increased blood supply can be compressed due to goitre
3 - blood vessels surrounding the thyroid will become narrowed
4 - all of the above

A

4 - all of the above

33
Q

If a patient with hyperthyroidism is not treated promptly, all of the following can happen, EXCEPT which one?

1 - atrial fibrillation
2 - osteoporosis
3 - autonomic dysfunction
4 - CKD

A

4 - CKD
- not typically associated with hyperthyroidism

34
Q

Patients with graves disease a form of hyperthyroidism can present with a number of clinical symptoms and signs. What cardiac drug can be used to treat patients who are are risk of tachycardia, palpitations and arrhythmias, providing they are not asthmatic?

1 - Class I (Na+ channel blockers)
2 - Class II (β-blockers)
3 - Class III (K+ channel blockers)
4 - Class IV (Ca2+ channel blockers)

A

2 - Class II (β-blockers)
- Propanolol is typically 1st line medication as it is not specific to any tissue and can therefore address a lot of the symptoms of hyperthyroidism
- Bisoprolol, Propranolol, Carvedilol or Atenolol

35
Q

Which 2 of the following medications can be used to treat a patient with hyperthyroidism?

1 - Levothyroxine
2 - Propylthiouracil
3 - Carbimazole
4 - Teriparatide

A

2 - Propylthiouracil
3 - Carbimazole
- 1st line treatment

  • both inhibit thyroid peroxidases (TPO)
  • no TPO means iodide cannot be turned into iodine and then T3 and T4
36
Q

All of the following medications should be avoided where possible in patients with hyperthyroidism, EXCEPT which one?

1 - digoxin
2 - diuretics
3 - amiodarone
4 - anticoagulants

A

1 - digoxin

37
Q

What is an important adverse event of Carbimazole?

1 - AKI
2 - agranulocytosis (low neutrophils)
3 - liver failure
4 - psychosis

A

2 - agranulocytosis (low neutrophils)

38
Q

Hyperthyroidism can be treated with radioactive Iodine 131 radiotherapy, which has a half life of 8 days. How does this treatment work?

1 - targets TSH receptors and reduces their numbers
2 - targets throid perioxidase (TPO) reducing T3 and T4 production
3 - thyroid tissue absorbs Iodine 131, which destorys thyroid tissue
4 - all of the above

A

4 - all of the above

39
Q

Hyperthyroidism can be treated with radioactive Iodine 131 radiotherapy, which has a half life of 8 days. This treatment works by destroying tissue via B radiation, and is concentrated in the thyroid as it uptake iodine. All of the following are important, EXCEPT which one when starting a patient on Iodine 131 radiotherapy?

1 - they are radioactive to others for 2 weeks
2 - they may set airport security alarms off
3 - could be risk of long term hypothyroidism
4 - patients renal function must be >100

A

4 - patients renal function must be >100

40
Q

In addition to medications and radiotherapy, patients may undergo surgery to treat the hyperthyroidism, either total or partial thyroidectomy. What must patients be prior to have either of these surgieries?

1 - <65 y/o
2 - euthyroid (normal thyroid function)
3 - BMI <35kg/m2
4 - hypothyroidism

A

2 - euthyroid (normal thyroid function)
- important for clinical outcomes post surgery

41
Q

In addition to medications and radiotherapy, patients may undergo surgery to treat the hyperthyroidism. Patients can have 2 surgeries, total or partial thyroidectomy. Which of the following is NOT a complication of these surgeries?

1 - anaesthetic and neck scar
2 - hypothyroidism
3 - hyperparathyroidism
4 - vocal cord palsy (recurrent laryngeal
- nerve damage)

A

3 - hyperparathyroidism
- typically causes hypoparathyroidism as the parathyroid glands are on the back of the thyroid

42
Q

Thyroid eye can be quite serious, what are some treatment options for this?

A
  • immunosuppressive
  • steroid/steroid-sparing
  • agents
  • radiotherapy
  • surgery
43
Q

Thyroid storm (also known as thyroid or thyrotoxic crisis) represents the severe end of the spectrum of thyrotoxicosis and is characterized by compromised organ function. Which of the following does NOT typically occur?

1 - decreased basal metabolic rate
2 - more proteins may be produced and more energy in the form of sugars and fats is burnt off, cells essentially going into hyperdrive
3 - T3 increases cardiac output
4 - stimulate bone resorption - thinning out the bones causing osteoporosis and fractures
5 - activates the sympathetic nervous system
6 - result in ICU and high mortality

A

1 - decreased basal metabolic rate (BMR)
- typically causes decreased BMR

44
Q

Thyroid storm, also known as thyrotoxic crisis, most commonly observed in graves disease is when there is a significant magnification of symptoms associated with elevated thyroid hormones. Where T3 is able to do the following, but in a much more accentuated version than normal:

1 - speed up the basal metabolic rate
2 - more proteins may be produced and more energy in the form of sugars and fats is burnt off, cells essentially going into hyperdrive
3 - increases cardiac output (tachycardia, arrhythmias, heart failure
4 - stimulate bone resorption - thinning out the bones
5 - activates the sympathetic nervous system (GI issues)
6 - result in ICU and high mortality

Which patients are likely to get this?

1 - aged >65 y/o
2 - females post partum
3 - undiagnosed Graves disease patients
4 - post surgical patients

A

3 - undiagnosed Graves disease patients
- could also be patients with Graves disease but are not compliant with medications

45
Q

Thyroid storm, also known as thyrotoxic crisis, most commonly observed in graves disease is when there is a significant magnification of symptoms associated with elevated thyroid hormones. Where T3 is able to do the following, but in a much more accentuated version than normal:

1 - speed up the basal metabolic rate
2 - more proteins may be produced and more energy in the form of sugars and fats is burnt off, cells essentially going into hyperdrive
3 - increases cardiac output (tachycardia, arrhythmias, heart failure
4 - stimulate bone resorption - thinning out the bones
5 - activates the sympathetic nervous system (GI issues)
6 - result in ICU and high mortality

This is common in patients with graves disease who are undiagnosed or patients with graves disease, but not compliant with treatment. Which of the following DOES NOT typically trigger the thyroid storm?

1 - pregnancy
2 - surgery
3 - acute severe illness
4 - hypoglycaemia

A

4 - hypoglycaemia

46
Q

What is the difference between thyrotoxicosis (toxic levels of thyroid hormones in the blood) and thyroid storm, also known as thyroid or thyrotoxic crisis (dangerous and significant increase in symptoms caused by hyperthyroidism)?

A
  • thyrotoxicosis - a common endocrine condition, generally secondary to a number of underlying processes
  • thyroid storm represents the severe end of the spectrum of thyrotoxicosis and is characterised by compromised organ function
47
Q

Thyrotoxic storm is very dangerous. The aim of treatment follows:

  • counteract peripheral effects of T3 and T4
  • inhibit further thyroid hormone production
  • treat systemic complications.

If the above does not made progress in 24h, what treatment should be discussed with the patient?

1 - induced coma
2 - thyroidectomy
3- steroids and antibiotics
4 - all of the above

A

2 - thyroidectomy

48
Q

Thyrotoxic storm is very dangerous. Which drug should be given to patients to reduce cardiac output and risk of arrhythmias?

1 - propanolol
2 - amiodarone
3 - flecainide
4 - any of the above

A

1 - propanolol
- if this is unsuccessful then can use digoxin
- BUT not amiodarone

C. Year 3 MLA Reproductive and Endocrinology (22 decks)

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