hyperthyroidism Flashcards

1
Q

what is Grave’s disease?

A

autoimmune

antibodies bind to and stimulate TSH receptors in thyroid gland

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2
Q

what does stimulation of the gland cause?

A
  • smooth goitre
  • exophthalmos
  • pretibial myxoedema
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3
Q

what is plummer’s disease?

A

not autoimmune but a benign adenoma

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4
Q

what are the symptoms of plummer’s?

A
  • toxic nodular goitre
  • no pretibial myxoedema
  • no exophthalmos
  • hot nodule on thyroid uptake scan
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5
Q

what are the symptoms of general hyperthyroidism?

A
  • weight loss
  • duspnoea
  • palpitations
  • tachycardia
  • sweating
  • diarrhoea
  • lid lag and other SNS features
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6
Q

what causes these SNS features?

A
  • thyroxine sensitises beta-adrenoreceptors to ambient levels of A/NA
  • leads to SNS activation
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7
Q

describe what happens in Viral (de Quervain’s) Thyroiditis

A

hyperthyroidism –> hypothyroidism

  • virus attacks thyroid gland
  • virus lyses the cell so thyroxine spill out into blood
  • thyroid not creating thyroxine
  • hyperthyroidism becomes hypothyroidism after a month
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8
Q

describe the features of this

A
  • painful/tender dysphagia
  • hyperthyroidism
  • pyrexia
  • raised ESR
  • zero iodine uptake on uptake scan
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9
Q

what is thyroid storm and its features?

A
  • medical emergency
  • hyperpyrexia
  • accelerated tachycardia/arrhythmia
  • cardiac failure
  • delirium/frank psychosis
  • hepatocellular dysfunction, jaundice
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10
Q

what treatment does thyroid storm need?

A
  • surgery
  • radioiodine
  • drugs
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11
Q

what are the different classes of drugs used to treat hyperthyroidism?

A
  • thionamides
  • potassium iodide
  • radioiodine
    all of these inhibit thyroxine synthesis
  • beta blockers
    combats symtpoms
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12
Q

name 2 examples of thionamides

A

Propylthiouracil

Carbimazole

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13
Q

what is the clinical use of thionamides?

A
  • daily treatment of hyperthyroid conditions
  • treatment prior to surgery
  • reduction of symptoms while waiting for radioiodine to act
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14
Q

what is the MoA of Thionamides?

A
  • inhibits TPO and peroxidase transaminase
  • supress antibody production in Graves
  • reduce T4 –> T3 in peripheral tissues
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15
Q

what are the unwanted effects of thionamides?

A
  • agranulocytosis (reduction of granular leukocytes)

- rashes

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16
Q

what are the pharmacokinetics of these?

A
  • orally active
  • carbimazole is pro-drug
  • plasma half life is 6-15 hours
  • crosses placenta
  • metabolised in liver, secreted in urine
17
Q

when is potassium iodide used?

A
  • preparation of hyperthyroid patients for surgery

- in severe thyroid storm crisis patients

18
Q

what is the MoA of potassium iodide?

A
  • inhibits iodination of TG
  • inhibits hydrogen peroxide
  • wolf-chaikoff effect
19
Q

what is the unwanted reaction with potassium iodide?

A

allergic reactions

20
Q

what does HIGH DOSE radioiodine treat?

A
  • hyperthyroidism

- thyroid cancers

21
Q

what is the MoA of this?

A

radioiodine accumulates in thyroid and emits beta particles

this destroy follicular cells

22
Q

what are the pharmacokinetics of iodine treatment?

A
  • single dose orally
  • half life of 8 days
  • negligible after 2 months