Hyperthyroidism Flashcards

1
Q

What is the definition of hyperthyroidism? [2]

A

an overactive thyroid / resulting in excessive production of thyroid hormone

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2
Q

What is the definition of thyrotoxicosis and what are its 3 mechanisms? [4]

A

excess thyroid hormone in the blood

  1. overproduction of thyroid hormone
  2. leakage of preformed hormone
  3. ingestion of excess hormone
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3
Q

What are the causes of hyperthyroidism? [5]

A
  1. Graves’ disease (most common)
  2. Toxic multinodular goitre
  3. Toxic adenoma
  4. Subacute de Quervain’s thyroiditis
  5. Drugs - amiodarone
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4
Q

What are the risk factors of Graves’ disease? [6]

A
  1. female gender (biggest risk factor)
  2. genetic (maternal family history)
  3. infection (E.coli and gram negative bacteria)
  4. stress
  5. smoking
  6. associated autoimmune disease (vitiligo, T1DM, Addison’s)
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5
Q

What is the pathophysiology of Graves’ disease? [5]

A

serum IgG autoantibodies known as TSH receptor stimulating antibodies (TSHR-Ab) / bind to and activate G-protein-coupled TSH receptors / stimulates thyroid hormone production / excess secretion of thyroid hormones / and hyperplasia of thyroid cells (thyroid enlargement and diffuse goitre)

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6
Q

What are the clinical signs specific to Graves’ disease? [5, 3, 3]

A
  1. Graves’ ophthalmopathy - retro-orbital inflammation / swelling of extraocular muscles / exophthalmos / and ophthalmoplegia
  2. pretibial myxoedema - raised purple-red skin lesions / above the lateral malleoli
  3. thyroid acropachy - clubbing and painful swelling of fingers and toes / and periosteal reaction in limb bones
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7
Q

How does amiodarone affect the thyroid? [3]

A

anti-arrhythmic drug / causes hyperthyroidism due to high iodine content / or can cause hypothyroidism by inhibiting the conversion of T4 to T3

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8
Q

What are the symptoms of hyperthyroidism? [7]

A
  1. sweating and heat intolerance
  2. palpitations
  3. irritability
  4. tremor
  5. weight loss and increased appetite
  6. oligomenorrhoea +/- infertility
  7. diarrhoea
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9
Q

What are the signs of hyperthyroidism? [8]

A
  1. tachycardia/irregular pulse
  2. fine tremors
  3. warm moist skin
  4. palmar erythema
  5. lid lag and ‘stare’
  6. goitre/nodules
  7. thyroid bruit
  8. Graves’ signs - ophthalmopathy, pretibial myxoedema, thyroid acropachy
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10
Q

What tests can you carry out to diagnose hyperthyroidism? [5]

A
  1. thyroid function tests (TFTs)
  2. thyroid autoantibodies
  3. TSH receptor stimulating antibodies (TSHR-Ab)
  4. ultrasound of thyroid
  5. isotope scan
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11
Q

What would you expect to find from the TFTs? [2]

A
  1. low TSH, high T4 and T3

2. in secondary hyperthyroidism (due to pituitary cause), high TSH, T4 and T3

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12
Q

What is diagnostic of Graves’ disease? [1]

A

increase in TSH-receptor-stimulating antibodies (TSHR-Ab)

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13
Q

What 2 drugs are used for control of hyperthyroid symptoms? [4]

A
  1. propranolol - rapid control of symptoms (beta blocker)

2. carbimazole - block thyroid hormone synthesis

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14
Q

What are the side effects of oral carbimazole? [3]

A

agranulocytosis / decreased white blood cell count / resulting in neutropenia

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15
Q

What are the 2 strategies of giving anti-thyroid drugs? [2]

A
  1. titration - carbimazole for 4 weeks / then reduce doses according to TFTs
  2. block-replace therapy - carbimazole + levothyroxine
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16
Q

What are the other methods of treatment apart from drugs? [3]

A
  1. radioiodine (iodine 131)
  2. subtotal thyroidectomy
  3. total thyroidectomy
17
Q

What are the indications for total thyroidectomy and what are the risks? [3, 3]

A
  1. indicated for those with a large goitre / suspicion of malignancy (toxic adenoma) / and Graves’ disease
  2. patients become hypothyroid / risk of damage to recurrent laryngeal nerve (hoarseness) / hypoparathyroidism
18
Q

What is thyrotoxic storm? [2]

A

medical emergency / severe hyperthyroidism with rapid T4 increase

19
Q

What is the presentation of thyrotoxic storm? [5]

A
  1. hyperpyrexia
  2. tachycardia
  3. confusion
  4. coma
  5. heart failure
20
Q

What is the treatment for thyrotoxic storm? [3]

A
  1. oral carbimazole
  2. oral propranolol
  3. IV hydrocortisone