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Endocrine SOH > Hyperthyroidism > Flashcards

Hyperthyroidism Flashcards

1
Q

Definition

A

Refers to conditions where there is over activity of the thyroid gland

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2
Q

Clinical features - general

A 
weight loss
increased appetite
fatigue
anxiety
Dry skin
Muscle weakness
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3
Q

Clinical features - hands

A

Tremor
Sweaty
Rapid fingernail growth

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4
Q

Clinical features - pulse

A

Tachycardic

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5
Q

Clinical features - eyes

A

Gritty
Double vision
Eye lid retraction

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6
Q

Clinical features - hair

A

Brittle

Thin

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7
Q

Clinical features - CNS

A

Irritability
Sleep disturbance
Heat intolerance

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8
Q

Clinical features - throat

A

Goitre

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9
Q

Clinical features - CVS

A

Palpitations

Cardiac failure

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10
Q

Clinical features - GI

A

Diarrhoea

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11
Q

Clinical features - reproductive

A

Oligomenorrhea

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12
Q

Management aim

A

Too much thyroid hormone is being produced so aim to block thyroid hormone synthesis, by blocking TPO

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13
Q

Management - first line

A

Carbimazole

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14
Q

Carbimazole - mechanism

A

Blocks the synthesis of new thyroid hormone by preventing iodine from attaching to thyroglobulin

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15
Q

Carbimazole - dosage

A

Daily

May take weeks to work - be patient

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16
Q

Carbimazole - side effects

A

Agranulocytosis

- risk is highest during first 6 weeks of treatment

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17
Q

Agranulocytosis

A

Absence of granulocytes/neutrophils in the blood which usually help to fight off infections.
Development of fever / throat infection / oral ulcer - stop carbimazole treatment immediately and get urgent FBC checked

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18
Q

Pt on carbimazole who then gets pregnant

A

Continue on carbimazole until 16 weeks and then switch to PTU

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19
Q

Pt pre-pregnant who is on carbimazole

A

Switch to PTU for first trimester

Switch to Carbimazole in 2nd and 3rd trimester

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20
Q

Propylthyouricil (PTU) - mechanism

A

Blocks the synthesis of new thyroid hormone by decreasing the conversion of T4 -> T3

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21
Q

PTU - use

A

Patient allergic/side effects from carbimazole

Pregnancy

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22
Q

Beta blockers - mechanism

A

Reduced activity of sympathetic nervous system

23
Q

Beta blockers - use

A

Immediate symptomatic relief

Doesn’t treat the disease itself

24
Q

Surgery

A

Sub-total thyroidectomy

25
Radio-active iodine - use
Persistent disease
26
Primary hyperthyroidism - definition
Disease affecting the thyroid gland itself
27
Primary hyperthyroidism - thyroid function
Increased T3, T4 levels | Decreased TSH levels (to compensate - -ve feedback)
28
Primary hyperthyroidism - investigations
Thyroid function tests Auto-antibodies - +ve : autoimmune - -ve: do an US
29
Primary hyperthyroidism - management
Carbimazole or PTU Beta-blocker Radio-active iodine Surgery
30
Primary hyperthyroidism - autoimmune condition
Grave's disease
31
Grave's disease - definition
Autoimmune cause of hyperthyroidism
32
Grave's disease - who gets it?
``` Younger patients (20-50) Mainly females ```
33
Grave's disease - cause
Genes | Environment - smoking
34
Grave's disease - pathogenesis
Lymphoid follicles present Pale Scalloping
35
Grave's disease - clinical features
``` Described previously Pretibial myexoedema (red lumps / rash on leg) Thyroid acropachy (finger clubbing) ```
36
Grave's disease - thyroid eye disease
Proptosis - bulging of eyeballs Lid lag Opthalmoplegia - swelling of pre-orbital tissues
37
Grave's disease - auto-antibodies
TRAb - if this is +ve, graves is highly likely and no need to image thyroid gland Anti-TPO Anti-thyroglobulin
38
Grave's disease - investigations
Auto-antibodies: TRAb +ve, Anti TPO +ve, Anti thyroglobulin +ve Iodine uptake scan - increased uptake in both lobes Doppler US Increased alk phos
39
Grave's disease - management
Carbimazole, PTU Mild: topical lubricants Severe: steroids, radioactive iodine, surgery Alternatively Put patient on high dose carbimazole to make patient hypothyroid then correct this by putting them on thyroxine for 6 months
40
Grave's disease - management of relapsed disease
Radioactive iodine
41
Secondary hyperthyroidism - definition
Disease affecting the hypothalamus or anterior pituitary gland There is no thyroid gland pathology
42
Secondary hyperthyroidism - thyroid function
Increased free T3, T4 Normal / increased TSH - *if thyroid hormone levels are high, TSH levels should be low
43
Subclinical hyperthyroidism - thyroid function
Normal free T3, T4 (these SHOULD be high) | Decreased TSH levels
44
Subclinical hyperthyroidism - what condition is this associated with?
Multi-nodular goitre
45
Severe hyperthyroidism - definition
Untreated / inadequately treated thyrotoxicosis
46
Severe hyperthyroidism - who gets it
Grave's patients with acute illness | Patients with recent thyroid surgery
47
Severe hyperthyroidism - clinical features
Respiratory / cardiac collapse Hyperthermia Exaggerated reflexes
48
Severe hyperthyroidism - management
``` High dose carbimazole Beta blockers Hydrocortisone IV fluids Lugol's iodine ```
49
Subacute thyroiditis (De Quervanin's) - definition
Hyperthyroid --> Hypothyroid --> Normal
50
Subacute thyroiditis (De Quervanin's) - cause
Viral infection
51
Subacute thyroiditis (De Quervanin's) - clinical features
Fever Viral symptoms Neck tenderness
52
Subacute thyroiditis (De Quervanin's) - investigations
``` Scintigraphy scan (low uptake throughout) Blood tests ```
53
Subacute thyroiditis (De Quervanin's) - management
Self limiting
54
Drug induced thyroiditis - drugs involved
Lithium | Amiodarone

Endocrine SOH (25 decks)

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