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endocrine > hyperthyroidism > Flashcards

hyperthyroidism Flashcards

1
Q

what is hyperthyroidism?

A

over-production of the thyroid hormones by the thyroid gland

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2
Q

what are the thyroid hormones?

A

triiodothyronine (T3) and thyroxine (T4)

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3
Q

what is meant by thyrotoxicosis?

A

effects of an abnormal and excessive quantity of thyroid hormones in the body

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4
Q

what is meant by primary hyperthyroidism?

A
  • due to thyroid pathology
  • the thyroid is behaving abnormally and producing excessive thyroid hormones
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5
Q

what is meant by secondary hyperthyroidism?

A
  • due to the pathology in the hypothalamus or pituitary
  • pituitary produces too much thyroid stimulating hormone
  • the hyperthalamus produces too much thyroid releasing hormone
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6
Q

what is meant by subclinical hyperthyroidism?

A
  • where thyroid hormones T3 and T4 are normal and TSH is suppressed
  • absent or mild symptoms
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7
Q

what is graves disease?

A
  • autoimmune condition
  • TSH receptor antibodies cause primary hyperthyroidism
  • the antibodies are produced by the immune system
  • they stimulate TSH receptors on the thyroid
  • this is the most common cause of hyperthyroidism
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8
Q

what is plummers disease and whats it also known as?

A
  • toxic multinodular goitre
  • where nodules develop on the thyroid gland
  • these are unregulated in the thyroid axis so produce excessive thyroid hormones
  • most common in patients over 50 years
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9
Q

what is exophthalmos, what’s another name for it and what causes it?

A
  • proptosis
  • bulging of the eyes
  • caused by graves disease
  • inflammation, swelling and hypertrophy of the tissue behind the eyeballs force them forward, causing them to bulge out their sockets
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10
Q

what is pretibial myxoedema and what causes it?

A
  • skin condition caused by deposits of glycosaminoglycans under the skin on the anterior aspect of the leg
  • gives skin a discoloured, waxy, oedematous apearence over this area
  • specific to graves
    is a reaction to the TSH antibodies
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11
Q

what are the 3 symptoms specific to graves disease?

A

exophthalmos / proptosis
pretibial myxoedema
goitre

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12
Q

what is goitre?

A
  • neck lump caused by the swelling of the thyroid gland
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13
Q

what are the causes of hyperthyroidism and what is the nemonic to remember this?

A

GIST
Graves disease
Inflammation (thyroiditis)
Solitary toxic thyroid nodule
Toxic multinodular goitre

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14
Q

What is thyroiditis and its initial and delayed effects?

A
  • inflammed thyroid gland
  • initial hyperthyroidism
  • followed by hypothyroidism
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15
Q

what are the causes of thyroiditis?

A
  • de quervains thyroiditis
  • hashimotos thyroiditis
  • postpartum thyroiditid
  • drug-induced thyroiditis
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16
Q

what is the universal presentation of hyperthyroidism?

A
  • anxiety and irritability
  • sweating and heat intolerance
  • tachycardia
  • weight loss
  • fatigue
  • insomnia
  • frequent loose stools
  • sexual dysfunction
  • brisk reflexes on examination
17
Q

what are the specific features of graves, relating to the presence of TSH receptor antibodies?

A
  • diffuse goitre (without nodules)
  • graves eye disease, including exophthalmos
  • pretibial myxoedema
  • thyroid acropachy (hand swelling and finger clubbing)
18
Q

in what situation may nodules be palpable?

A

in patients with toxic multinodular goitre

19
Q

what is solitary toxic thyroid nodule and treatment?

A
  • a single abnormal thyroid nodule acts alone, releasing excessive thyroid hormone
  • usually benign adenomas
  • treatment involves surgical removal
20
Q

what is de quervains thyroiditis and whats another name for it?

A
  • subacute thyroiditis
  • condition causing temporary inflammation of thyroid gland
21
Q

what are the 3 phases of de quervains thyroiditis?

A
  • thyrotoxicosis
  • hypothyroidism
  • return to normal
22
Q

what does the initial thyrotoxic phase of de quervains thyroiditis involve?

A
  • excessive thyroid hormones
  • thyroid swelling and tenderness
  • flu-like illness (fever, aches and fatigue)
  • raised inflammatory markers (CRP and ESR)
23
Q

what is the treatment for de quervains thyroiditis?

A
  • its a self-limiting condition so supportive treatment is usually all that is necessary

-NSAIDs - for pain and inflammation
- beta blockers - for hyperthyroidism
- levothyroxine - for hypothyroidism

24
Q

what is thyroid storm and what does it present with?

A
  • more severe and rare presentation of hyperthyroidism
  • also known as thyrotoxic crisis

presentation:
- fever
- tachycardia
- delirium

25
Q

what are some treatment options for those with hyperthyroidism?

A
  • first-line - carbimazole
  • second-line - propylthiouracil
  • radioactive iodine
  • beta blockers
  • surgery
26
Q

what is the first-line drug for hyperthyroidism and describe its admission?

A
  • carbimazole
  • taken for 12-18 months
  • once patient has normal levels usually after 4-8 weeks they continue on maintenence carbimazole
    AND EITHER
  • titration block (titrated carbimazole to maintain normal levels)
  • ## block and replace - a higher dosage of carbimazole which blocks all thyroid hormone production, and levothyroxine which brings it back
27
Q

whats the second-line method of treatment for hyperthyroidism, how is it used and why is it not preferred?

A
  • propythiouracil
  • used in a similar way as carbimazole
  • small risk of severe liver reactions, including death
28
Q

what does radioactive iodine treatment involve?

A
  • drinking a single dose of radioactive iodine
  • the thyroid gland takes this up
  • the emitted radiation destroys a proportion of the thyroid cells
  • the reduction in cells leads to a decrease in thyroid hormone production
  • remissio can take 6 months after which the thyroid is underactive
  • means long term levothyroxine is required
29
Q

what are the strict rules of levothyroxine?

A
  • women must not be pregnant or breastfeeding and must not get pregnant within 6 months of treatment
  • men must not father children within 4 months of treatment
  • limit contact with people after the dose, especially children and pregnant women
30
Q

describe how beta-blockers are used in hyperthyroidism treatment?

A
  • they block the adrenalin-related symptoms of hyperthyroidism
  • propanolol is the usual drug as it non-selectively blocks adrenergic activity
  • useful in patients with thyroid storm - doesnt treat the underlying problem
31
Q

explain what surgeries are available and what is the concequence of them?

A
  • removing whole thyroid gland
  • removing only the toxic nodules
  • patients will be hypothyroid after so will require life-long levothyroxine

endocrine (4 decks)

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