hyperthyroidism

Question 1

define hyperthyroidism

Answer 1

Overproduction of thyroid hormones, T3 and T4.

Question 2

what is T3?

Answer 2

Triiodothyronine

Question 3

what is T4?

Answer 3

Thyroxine

Question 4

describe primary hyperthyroidism

Answer 4

Abnormal thyroid function leading to excessively produced thyroid hormones.

Question 5

describe secondary hyperthyroidism

Answer 5

Abnormal hypothalamus or pituitary function leading to excess TSH which in turn leads to excess T3 and T4.

Question 6

what can be seen in subclinical hyperthyroidism?

Answer 6

Mild symptoms may be seen in subclinical hyperthyroidism, but levels of T3 and T4 are normal.

Question 7

describe what happens in Graves disease?

Answer 7

-TSH Antibodies stimulate TSH receptors in the thyroid.
-it is an autoimmune condition.
( most common cause )

Question 8

what happens during toxic multi nodular goitre/ plummers disease?

Answer 8

is where nodules on the thyroid produce excess thyroid hormones
( Solitary Toxic Thyroid Nodule - is the same but one nodule only)

Question 9

what can inflammation of the thyroid gland lead to ?

Answer 9

can lead to thyrotoxicosis (excessive T3 and T4).
then lead to hypothyroidism.

Question 10

what is a thyroid storm/ thyrotoxic crisis?

Answer 10

It is a severe presentation and can present with fever, delirium and tachycardia.

Question 11

how is a thyroid storms treated ?

Answer 11

It is life-threatening but treated mostly the same except for additional fluids, anti-arrhythmic medication and beta blockers.

Question 12

what are the Graves specific signs ?

Answer 12

-Exophthalmos (bulging eyes)
-Pretibial myxoedema (bruised legs)
-Thyroid acropachy (clubbed fingers)

Question 13

what are the symptoms for hyperthyroidism?

Answer 13

-Weight Loss
-Sweating/Heat Intolerance
-Palpitations
-Oligomenorrhoea
-Anxiety

Question 14

what is the epidemiology for hyperthyroidism?

Answer 14

Middle aged women
Family history
Autoimmune diseases

Question 15

what is the first line of treatment/ management for hyperthyroidism?

Answer 15

• CARBIMAZOLE
  -you can also add a beta blocker to help with symptom relief

Question 16

why should you be careful with carbimazole?

Answer 16

-as it can cause agranulocytosis (can be detected by a sore throat)
- first trimester foetal abnormalities.

Question 17

what is the second line of treatment/managment for hyperthyroidism?

Answer 17

Propylthiouracil.
This however has a small risk of severe hepatic reaction and death. It too can cause agranulocytosis.

Question 18

what is a risk of Propylthiouracil?

Answer 18

This however has a small risk of severe hepatic reaction and death. It too can cause agranulocytosis.

Question 19

what is the last resort of treatment/management for hyperthyroidism?

Answer 19

Surgery or Radio-iodine treatment.

Question 20

what can you give post hyperthyroidism treatment to prevent hypothyroidism?

Answer 20

levothyroxine

Question 21

what diagnostic tests can you do for hyperthyroidism?

Answer 21

-Thyroid Function Tests
- anti- TSH receptor antibodies
- anti TPO antibodies
- Thyroid ultrasound

Question 22

what does a positive anti TSH receptor antibodies test tell you?

Answer 22

GRAVE’S DISEASE.

Question 23

what do the presence of anti TPO antibodies tell you ?

Answer 23

-in most Grave’s Disease and Hashimoto’s thyroiditis.
-It is more common in hypothyroidism though.

Question 24

In a thyroid function test what would primary hyperthyroidism show?

Answer 24

TSH- low
T3 + T4- high

Question 25

In a thyroid function test what would subclinical hyperthyroidism show?

Answer 25

TSH- low
T3 + T4- normal

Question 26

In a thyroid function test what would secondary hyperthyroidism show?

Answer 26

TSH- high
T3+T4- high