HYPERTHYROIDISM Flashcards
What are signs of hyperthyroidism?
goitre
palpitations
anxiety
heat intolerance
increased appetite with unintentional weight loss
Diarrhoea
What are complication if hyperthyroidism?
Grave’s orbitopathy
Thyrotoxicosis crisis
Pregnancy complication
Reduced bone mineral density
Heart failure
AF
What are risk factors of hypothyroidism?
Smoking
Family history
co-existent autoimmune
Low iodine intake
What is primary hyperthyroidism?
When the condition arises from the thyroid gland rather than due to a pituitary or hypothalamic disorder.
Caused mainly by;
Graves’ disease
Drug induced thyrotoxicosis
Toxic nodular goitre
More common in women
What is graves disease
An autoimmune disorder mediated by antibodies that stimulate the thyroid-stimulating hormone (TSH) receptor.
What drugs are used to treat hyperthyroidism?
Carbimazole
Propylthiouracil
If patients are intolerant or for those who experience sensitivity reactions
Radioactive sodium iodide
Surgery
CARBIMAZOLE;
What is MHRA warnings of drug?
Can cause;
Neutropenia and agranulocytosis
Increased risk of congenital malformations; especially in first trimester and at high doses (>15mg)
Risk of acute pancreatitis
What is treatment for thyrotoxicosis?
Propanolol
CARBIMAZOLE;
What are doses?
15–40 mg daily continue until the patient becomes euthyroid, usually after 4 to 8 weeks.
higher doses should be prescribed under specialist supervision only, then reduced to 5–15 mg daily, reduce dose gradually, therapy usually given for 12 to 18 months.
When substituting carbimazole and propylthiouracil, what dose adjustments need to be made?
1mg carbimazole = propylthiouracil 10mg
May need to be adjusted based on response
HYPERTHYROIDISM in PREGNANCY;
What advise is given to women with trying to get pregnant hyperthyroidism?
Use effective contraception
Pregnancy females must be referred immediately
If they start showing signs of hyperthyroidism should be admitted to hospital.
Women who have recieved sodium iodine radioactive should be advised to avoid becoming pregnant for at least 6 months after.
HYPERTHYROIDISM in PREGNANCY;
What can be given during pregnancy?
Propylthiouracil
BUT not during blocking replacement therapy (carbimazole + propylthiouracil)
It does cross the placenta and inhigh doses may cause fetal goitre and hypothyroidism—the lowest dose that will control the hyperthyroid state should be used.
PROPYLTHIOURACIL;
What are monitoring requirements?
Hepatotoxicty
PROPYLTHIOURACIL;
What is dosage?
200-400mg daily divided doses until becomes euthyroid then reduce by 50-150mg daily.
PROPYLTHIOURACIL;
is it safe in breastfeeding?
yes but monitor development closely
lowest effective dose used
