Hyperthyroidism

Question 1

What is the difference between thyrotoxicosis and hyperthyroidism?

Answer 1

Thyrotoxicosis is a state of elevated T3 and T4.

Hyperthyroidism is too much T3 and T4 because of hyper function of the thyroid gland itself.

Question 2

Define primary and secondary hyperthyroidism?

Answer 2

Primary is a problem with the gland itself spitting out too much hormone and secondary is a tumor somewhere else causing the gland to spit out too much, like a pituitary tumor spitting out too much TSH.

Question 3

What are the three most common causes of primary thyrotoxicosis?

Answer 3

Diffuse Hyperplasia of the thyroid with Graves (most common)
Hyper functioning multi nodular goiter
Hyper functioning thyroid adenoma

Question 4

What is the one cause of secondary hyper she wants us to know, but what is the caveat?

Answer 4

Pituitary adenoma, but rare

Question 5

Lab value wise, what is the main difference between primary and secondary hyper?

Answer 5

Primary will have low TSH levels and secondary will have high TSH levels.

Question 6

Clinical manifestations of hyper thyroid presents as what big picture?

Answer 6

Increased sympathetic nervous system symptoms and an increased adrenergic state

Question 7

Explain what thyroid storm is and the 4 areas of clinical symptoms that we see?

Answer 7

Sudden and abrupt onset of clinical symptoms due to hyperthyroidism.
Fever
Cardiac
GI
Precipitating history like surgery, infection, drugs.

Question 8

What 2 meds can we give to control symptoms of hyper?

Answer 8

Beta blockers and NSAIDS

Question 9

What 3 things can we do to treat the underlying hyper part of the disease?

Answer 9

Iodine to block the release of hormone, thionamide to block new hormone synthesis, and radioiodine ablation to stop the the thyroid gland from functioning at such a high level.

Question 10

What is the most common cause of endogenous hyper?

Answer 10

Graves’ disease

Question 11

What is the classical clinical triad for Graves?

Answer 11

Hyperthyroidism with diffuse enlargement of the gland
Infiltrative ophthalmopathy
Pretibial myxedma

Question 12

What is the peak age and gender most affected for graves?

Answer 12

20-40

Women

Question 13

What is the patho of graves?

Answer 13

Autoantibodies against TSH receptor

Question 14

What is the most common autoantibody and what is its effect on the thyroid gland?

Answer 14

TSI which continually stimulates the receptor, hence hyperthyroidism

Question 15

What is responsible for stimulating the autoimmune reaction in the eyes in Graves’ disease?

Answer 15

Fibroblasts which express the TSH receptor

Question 16

What is the patho for the eyes in Graves’ disease?

Answer 16

Lymphocytes invade the preorbital space.
Edema and swelling of the EOM
Accumulation of matrix
Increased number of fat cells

Question 17

2 things we would see with a thyroid with Graves’ disease if we removed the thyroid and looked at it?

Answer 17

Symmetrically enlarged due to diffuse hypertrophy and hyperplasia of the follicular epithelium

Question 18

What 3 lab values corresponds to Graves’ disease?

Answer 18

T3/T4 elevated
TSH low
TSI elevated