Hyperthyroidism Flashcards
What hormones does the thyroid gland make?
Triiodothyronine (T3) and Thyroxine (T4)
T_____ refers to the effects of an abnormal and excessive quantity of thyroid hormones in the body
Thyrotoxicosis
Primary hyperthyroidism is due pathology where?
In the thyroid itself, producing excessive thyroid hormone
Secondary hyperthyroidism is due to pathology in the…
hypothalamus or pituitary gland
The pituitary gland produced too much TSH (thyroid stimulating hormone)
What is the most common cause of hyperthyroidism?
Grave’s disease
Grave’s disease is an _____ condition
autoimmune
In Grave’s disease, what antibodies cause primary hyperthyroidism?
TSH receptor antibodies (produced by immune system)
What is toxic multinodular goitre?
Also called Plummer’s disease
Nodules develop on thyroid gland, not regulated by TSH axis so continuously make excessive thyroid hormones.
What age group is toxic multinodular goitre most common in?
Patients over 50
What are common symptom of Graves’ disease?
Proptosis (also called exophthalmos)
Pretibial myxoedema
Goitre
Thyroid acropachy (hand swelling and finger clubbing)
Why is proptosis seen?
Inflammation, swelling and hypertrophy of the tissue behind the eyeballs force them forward, causing them to bulge out of the sockets.
Why is pretibial myxoedema seen?
Deposits of glycosaminoglycans under the skin on the anterior aspect of the leg gives the skin a discoloured, waxy, oedematous appearance. Reaction to TSH receptor antibodies.
What are the causes of hyperthyroidism?
Think GIST
Grave’s disease
Inflammation (eg thyroiditis)
Solitary toxic thyroid nodule
Toxic multinodular goitre
What are some universal feature of hyperthyroidism?
Fatigue
Insomnia
Anxiety
Irritability
Sweating
Heat intolerance
Weight loss
Frequent loose stools
Sexual dysfunction
Brisk reflexes on examination
The nodules seen in solitary toxic thyroid nodule and toxic multinodular goitre are usually benign ______ and treatment involves surgical removal
adenomas
What is struma ovarii?
Rare ovarian tumour where over 50% of its mass is made from thyroid tissue
What is de Quervain’s thyroiditis and what are the 3 phases?
Also called subacute thyroiditis.
Temporary inflammation of thyroid gland
Thyrotoxicosis
Hypothyroidism
Return to normal
What does the initial thyrotoxic phase of de Quervain’s thyroiditis involve?
Excessive thyroid hormones
Thyroid swelling and tenderness
Flu-like illness
Raised inflammatory markers
What triggers de Quervain’s thyroiditis?
Believed to be triggered by a viral infection such as enteroviruses like coxsackie virus
How do you treat de Quervain’s thyroiditis?
Self-limiting condition
May give NSAIDS for pain and inflammation
Beta blocker for symptoms of hyperthyroidism
Levothyroxine for symptoms of hypothyroidism
What is a thyroid storm?
Also called thyrotoxic crisis, rare and most severe presentation of hyperthyroidism.
Often abrupt onset and triggered by infection, surgery, trauma or discontinuation of anti-thyroid medication.
Presents with fever, tachycardia and delirium.
What additional supportive care may be given for a thyroid storm?
Anti-thyroid medication = propylthiouracil
Potassium iodide
Fluid resuscitation, anti-arrhythmic medication and beta blockers
What is the first line anti-thyroid drug for hyperthyroidism?
Carbimazole.
Once patient has normal thyroid hormone levels after 1-2 months, continue on maintenance carbimazole
What is “titration-block” method for hyperthyroidism?
Once thyroid hormone levels are normal with carbimazole, the dose is titrated to maintain the normal levels.
