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Hyperthyroidism Flashcards

1
Q

What are the hormone levels is primary hyperthyroidism?

A

TSH low
fT4 high
fT3 high

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2
Q

What are the hormone levels in secondary hyperthyroidism?

A

TSH high
fT4 high
fT3 high

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3
Q

What are the causes of hyperthyroidism?

A 
Grave's disease
Iodine overdose
Drugs
Thyroiditis
Nodular
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4
Q

What is Grave’s disease?

A

Autoimmune

Thyrotoxicosis

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5
Q

What is the etiology for Grave’s disease?

A

F>M

20-50 years

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6
Q

What are the risk factors for Grave’s disease

A

Viral trigger
Smoking
High iodine intake
Genetics/FHx

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7
Q

What is the prognosis of Grave’s disease?

A

50% recover

50% relapse

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8
Q

What tests can you do for Grave’s disease?

A

High T3/T4, Low TSH
Thyroid antibodies positive
Scintigraphy: high uptake/Ultrasound

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9
Q

What are the signs of Grave’s disease?

A 
Pretibial myxoedema (doughy)
Smooth symmetrical goitre
Lid retraction 
Lid lag
chemosis 
vision loss
diplopia
proptosis
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10
Q

Why does pretibial myxoedema happen in Grave’s disease?

A

pretibial accumulation of hydrophillic mucopolysaccharide at the dermis

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11
Q

What antibodies can you look for in Grave’s disease?

A 
Anti TPO (70-80%)
Anti TG (30-50%)
TSH receptor antibody (70-100%)-stimulating
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12
Q

What is a nodular cause of hyperthyroidism?

A 
multinodular goitre
toxic nodule (adenoma)
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13
Q

What are sources of iodine overdose?

A

amiodarone
thyroxine
kelp supplements

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14
Q

What medications can cause hyperthyroidism?

A

lithium

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15
Q

What are the GI symptoms of hyperthyroidism?

A

frequent loose bowel movements

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16
Q

What are the gynae symptoms of hyperthyroidism?

A

lighter periods

oligomenorrhoea (less frequent periods)

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17
Q

What are the opthomogical symptoms of hyperthyroidism?

A 
lid retraction
exopthalamus
diplopia 
lid lag
chemosis
vision loss
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18
Q

What are the CNS symptoms of hyperthyroidism?

A

anxiety
irritability
sleep disturbance

19
Q

What are the hair and nail changes in hyperthyroidism?

A

brittle hair
thin hair
Rapidly growing nails

20
Q

What are the MSK symptoms of hyperthyroidism?

A

Muscle weakness (especially proximal limbs)

21
Q

What are the metabolic changes in hyperthyroidism?

A

Weight loss

increased appetite

22
Q

What are the thermogenic changes in hyperthyroidism?

A

heat intolerance

23
Q

How does a nodular thyroid present?

A

insidious onset
older population
gland feels nodular
assymetrical goitre

24
Q

What would antibody screening show in a nodular thyroid?

A

Antibody negative

25
Q

What are the hormone levels with a nodular thyroid?

A

fT4/fT3 high

TSH low

26
Q

What is De Quiveran’s thyroiditis?

A

Subacute thyroiditis

27
Q

What is the etiology of De Quiveran’s?

A

F>M

20-50years

28
Q

What are the risk factors for developing De Quiveran’s?

A

Viral trigger (associated viral symptoms eg sore throat)

29
Q

What is the length of disease in De Quiveran’s

A

Resloves in a few months

30
Q

What is the hormone level profile in De Quiveran’s?

A

Euthyroid (normal T3/T4)
Hyperthyoid (High T3/T4)
Hypothyroid (Low T3/T4)
Euthyroid (normal T3/T4)

31
Q

What are the hormone levels in sub-clinical hyperthyroidism?

A

Normal T3/T4
Low TSH
mildly overactive

32
Q

What is the 1st line treatment for hyperthyroidism?

A

Carbimazole

33
Q

What mechanism does carbimazole target?

A

Iodine attraction to tyrosine within thyroglobulin colloid

34
Q

When should carbimazole not be used and what should be used instead?

A 
Pregnancy
use propylthiouracil (PTU)
35
Q

What other drugs should be used to manage symptoms of hyperthyroidism and why?

A

Beta blockers
symptoms are sympathomemetic
therefore dulls down sympathetic response

36
Q

How should Grave’s disease be treated?

A

Carbimazole
High dose over 12-18months
Then stop treatment to prevent hypothyroid

37
Q

What treatments for hyperthyroidism would be considered after drug therapy?

A

Radioiodine

Surgery

38
Q

What precautions does the patient have to take after radioiodine?

A

avoid long contact with children or pregnant women
Don’t share a bed with someone else
Avoid pregnancy for 6 months
Ensure not pregnant

39
Q

What are the risks of radioiodine treatment?

A

Hypothyroid

especially in Grave’s

40
Q

What are the risks of surgery in hyperthyroidism?

A 
scar
recurrent laryngeal nerve palsy
anaesthetic risk
hypothyroid
hypoparathyroid
41
Q

What are the complications of hyperthyroidism in pregnancy?

A 
infertility
spontaneous miscarriage
stillbirth
thyroid crisis in labour
transient neonatal thyrotixicosis
42
Q

How is it difficult to distinguish hyperthyroidism from nausea in pregnancy?

A 
N+V
tachycardia
warm
sweaty
lack of weight gain
43
Q

How do you manage hyperthyroid in pregnancy?

A

Wait and see (supportive)
B blockers in early pregnancy
LOW DOSE PTU 1/3
Carbimazole 2/3

Endocrinology (17 decks)

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