Hyperthyroidism

Question 1

Name the two causes hyperthyroidism

Answer 1

1. Graves’ disease

2. Modular goitre (plumbers disease)

Question 2

Explain Graves’ disease

Answer 2

Autoimmune disease (antibodies bind to TSH receptor and stimulate thyroid gland to make thyroxine) it causes goitre smooth growth and lid lag.

Typical symptoms: over reactive, nervous, anxious, rapid pulse, warm, non pitting oedema, expthalamus (antibodies bind to growth factor behind eye and push eye forward), heart failure.

On palpitation of thyroid gland you will feel diffused smooth growth of thyroid gland, diagnostic via radioactive imaging of iodine thyroid.

Question 3

Explain the effects of plummers disease

Answer 3

Toxic modular goitre, not autoimmune, benign adenoma that is overactive at making thyroxine. No peritbeal myxodeam and no exopthalamus

Presentation: iodine scan, showing iodine going into tumour because there is so much thyroxine the pituitary gland will stop making TSH and the thyroid gland will shrink on one side

Symptoms: weight loss, breathlessness, palpitations, sweating, heat intolerance, diarrhoea, lid lag

Question 4

Describe the effects of a thyroid storm

Answer 4

Medical emergency, confirmed via blood test, hyperprexia (>41), accelerated tachycardia, cardiac failure, delirium, Frank psychosis, jaundice.

Question 5

Describe the different treatments for hyperthyroidism.

Answer 5

1. The thioamides: (anti thyroid): PTU and carbimazole (prodrug converted ti methimazole) p. They work by inhibiting TPO, hence the reduction of synthesis of T4. But causes agranulocytosis and rash.
2. Potassium iodide: preparation of hyperthyroid patients for surgery or if someone is having a thyroid storm. It causes an auto regulatory phenomenon where the thyroid stops taking in iodine and therefore less thyroxine
3. Radioidine: high dose of 131-I. Last resort treatment for hyperthyroidism and thyroid cancer

Question 6

Describe the effects and symptoms of viral thyroiditis

Answer 6

Painful dysphagia, hyperthyroidism, pyrexia, raised ESR, attacks thyroid gland, causing pain and tenderness, thyroid stops making thyroid and makes virus instead then becomes hypothyroidism