Hyperthyroidism Flashcards
What is hyperthyroidism?
Over production of T3 and T4 by the thyroid gland
What is thyrotoxicosis?
The effects an abnormal and excessive quantity of thyroid hormones has on the body
What is the universal cause of primary hyperthyroidism?
Thyroid pathology - behaving abnormally
What is the universal cause of secondary hyperthyroidism?
Hypothalamus OR pituitary pathology
What is subclinical hyperthyroidism?
The thyroid hormones are normal and TSH is suppressed
What is Grave’s disease?
An autoimmune condition where TSH receptor antibodies cause primary hyperthyroidism by activating TSH receptors on the thyroid
What is toxic multinodular goitre?
A condition where nodules develop on the thyroid gland and continuously produce excessive thyroid hormones
What is exophthalmos?
How does it occur?
Bulging of the eyes due to Grave’s disease
Inflammation, swelling and hypertrophy of tissue behind the eye push them forwards
What is a goitre?
A neck lump caused by swelling of the thyroid gland
What is pretibial myxoedema?
How does it present?
A skin condition caused by deposits of glycosaminoglycans under the pre-tibial area of the leg
It gives the skin a discoloured, waxy, oedematous appearance
What symptom does TSH receptor antibodies cause only in Grave’s disease patients?
Pretibial myxoedema
What are the most common causes of hyperthyroidism?
Use the GIST pneumonic
Grave’s disease
Inflammation (thyroiditis)
Solitary toxic thyroid nodule
Toxic multinodular goitre
What response does thyroiditis cause in a patient?
Initial period of hyperthyroidism followed by hypothyroidism
Give 4 causes of thyroiditis?
De Quervain’s thyroiditis
Hashimoto’s thyroiditis
Postpartum thyroiditis
Drug-induced thyroiditis
What are the common clinical features of hyperthyroidism?
Anxiety / irritability
Sweating / heat intolerance
Tachycardia
Weight loss
Fatigue / insomnia
Frequent loose stools
Sexual dysfunction
What is thyroid acropachy?
Hand swelling and finger clubbing due to Grave’s disease
What is the most common presentation of a solitary toxic thyroid nodule?
Benign adenoma
What is the treatment of choice for a solitary toxic thyroid nodule?
Surgical removal
How does De Quervain’s thyroiditis present clinically?
Thyroid swelling and tenderness
Flu-like illness
How is De Quervain’s thyroiditis managed?
NSAIDs for pain / inflammation
Beta blockers for hyperthyroidism
Levothyroxine for hypothyroidism
What is a thyroid storm?
A severe presentation of hyperthyroidism with fever, tachycardia and delirium
What is the first line anti-thyroid drug?
Carbimazole
What further treatment is given for hyperthyroidism?
Maintenance carbimazole:
The dose is titrated to maintain normal levels
OR
A higher dose is given and levothyroxine is added and titrated to effect (block and replace)
What is the second line anti-thyroid drug?
Propylthiouracil
