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Endocrinology > Hyperthyroidism > Flashcards

Hyperthyroidism Flashcards

1
Q

What age is mainly affected?

A

20-40 yrs

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2
Q

What are the main causes of hyperthyroidism?

A
  1. Graves disease
  2. Toxic multi nodular goitre
  3. Toxic thyroid adenoma
  4. De Quervains’s thyroiditis
  5. Drug induced - amiodarone
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3
Q

How does hyperthyroidism present?

A
  • palpitations
  • diarrhoea
  • WL + increased appetite
  • Oligomenorrhoea +/- infertility
  • Heat intolerance
  • Irritability/behavioural change
  • Tremor
  • Hyperkinesis
  • Proximal myopathy + muscle wasting
  • Palmar erythema, fine tremor
  • Diffuse goitre
  • Lid lag + stare
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4
Q

What features can occur in elderly in hyperthyroidism ?

A

AF

Other tachycardias and/or HF

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5
Q

What features can occur in children in hyperthyroidism?

A

XS height or growth rate

Behavioural problems - hyperactivity

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6
Q

What signs are specific to Graves disease?

A
  1. Eye disease - exophthalmos, ophthalmoplegia
  2. Pretibial myxoedema
  3. Thyroid acropachy - clubbing, painful finger + toe swelling, periosteal reaction limb bones
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7
Q

What tests would u do to diagnose hyperthyroidism?

A

TFTs:

  1. TSH suppressed
  2. T3+T4 raised - diagnostic
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8
Q

What tests would u do to differentiate the cause of hyperthyroidism?

A

US of thyroid - diff between Graves + toxic adenoma

TSH receptor stimulating abs (TSHR-Ab) raised - diagnostic of Graves

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9
Q

What is Graves disease?

A

autoimmune induced XS production of thyroid hormone

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10
Q

What sex is graves more common in?

A

females

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11
Q

What age does graves typically present?

A

40-60

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12
Q

What are the RFs of Graves?

A
  1. Female (onset common postpartum)
  2. Genetic - HLA-B8, DR3 + DR2
  3. Smoking
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13
Q

Explain the pathophysiology behind Graves disease

A

TSH receptor stimulating antibodies (TSHR-Ab) - serum IgG abs specific for Graves - bind to TSH receptors in the thyroid
Stimulate T3 + T4 production
Results in XS secretion of thyroid hormones + hyperplasia of thyroid follicular cells -> hyperthyroidism + diffuse goitre

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14
Q

What is toxic multi nodular goitre?

A

nodules secrete thyroid hormones

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15
Q

What is de quervains thyroiditis?

A

transient hyperthyroidism resulting from acute inflammation of the thyroid gland

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16
Q

How does amiodarone lead to hyperthyroidism?

A

high iodine content

17
Q

What are medical treatments of hyperthyroidism?

A
  1. Antithyroid drugs -carbimazole or thiamazole
  2. Propanolol - control sx
    OR
  3. Radioactive iodine
18
Q

What are surgical options for hyperthyroidism? when are they indicated?

A

thyroidectomy

I: large goitre, malignancy suspected, mod-severe active Graves

19
Q

What are the different regimens of medical treatment ?

A
  1. Titration

2. Block-replace therapy - oral carbimazole + thyroxine - less risk of hypothyroidism

20
Q

What is the main SE of carbimazole? what do u need to watch out for

A

AGRANULOCYTOSIS - severely low WBC, most commonly neutropenia
Watch out for: sore throat, mouth ulcers, fevers

21
Q

When is radioactive iodine contraindicated?

A

pregnancy

breast feeding

22
Q

How Does radioactive iodine therapy work? ow long does it take to work?

A

iodine needed for thyroid hormone production so readily taken up by thyroid gland
accumulates and results in local irradiation
takes 4-12 weeks

23
Q

What re SE of radioactive iodine therapy?

A

discomfort in neck + hyperthyroidism initially

24
Q

How should you manage patients medically before thyroidectomy?

A

Stop antithyroid drugs 10-14 days before

Give potassium iodide to reduce vascularity of gland

25
Q

What are complications of thyroid surgery?

A

tracheal compression from post-op bleeding
Laryngeal nerve palsy
Transient hypocalcaemia due to removal of parathyroid gland

26
Q

what is the main hyperthyroid emergency?

A

THYROID STORM

Rapid deterioration of thyrotoxicosis - rapid T4 increase

27
Q

What are the features of thyroid storm?

A 
Hyperpyrexia 
Tachycardia 
Agitation + confusion
coma 
eventually death
28
Q

What are the precipitants of thyroid storms/

A 
Recent thyroid surgery 
Radioactive iodine therapy 
Infection
MI 
Trauma
29
Q

What is the management of thyroid storm?

A
  1. IV access, fluids, NG if vomiting
  2. Take bloods for T3, T4, TSH, cultures - don’t wait for results to treat
  3. Sedate if necessary e.g. chlorpromazine
  4. Propanolol max IV dose 1mg over 10min, if CI, diltiazem
  5. CARBIMAZOLE 15-25mg/6hr PO or propulthiouracil, after 4h give Lugol’s solution
  6. Hydrocortisone 100mg/6hr
  7. Rx suspected agitation

Endocrinology (21 decks)

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