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Endocrine: The Thyroid > Hyperthyroidism > Flashcards

Hyperthyroidism Flashcards

1
Q

define

A

overactive thyroid gland due to excess production of T3 and T4

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2
Q

causes

A 
most= Grave's
hyperfunctioning nodules 
tumours
TSH secreting adenomas
thyroiditis
ectopic production (struma ovarii)
factitious (exogenous intake)
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3
Q

define thyrotoxicosis

A

physiological state where tissues are exposed to excess thyroid hormone caused by anything
hyperthyroidism is caused by only the thyroid gland

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4
Q

thyrotoxicosis causes associated with hyperthyroidism

A

excessive thyroid stimulation e.g. Grave’s, Hashitoxicosis, thyrotropinoma (TSHoma), thyroid cancer and choriocarcinoma
thyroid nodules with autonomous function e.g. multinodular goitre or toxic solitary nodule

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5
Q

thyrotoxicosis causes not associated with hyperthyroidism

A
  • thyroiditis e.g. subacute, post-partum and drug-induced
  • exogenous thyroid hormones e.g. over treatment with levothyroxine and thyrotoxicosis factitia
  • ectopic thyroid tissue e.g. metastatic thyroid carcinoma and struma ovarii (teratoma containing thyroid tissue)
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6
Q

presentation of thyrotoxicosis

A
  • cardiac= palpitations, AF, HF
  • sympathetic= tremour, sweating
  • CNS= anxiety, nervous, irritable, insomnia
  • GI= frequent, loose stools
  • vision= lid retraction, double vision (diplopia) and proptosis (Grave’s)
  • brittle, thin hair
  • rapid finger nail growth
  • light bleeding and less frequent periods
  • proximal muscle weakness
  • increased BMR, weight loss despite increased appetite
  • thermogenesis: intolerance to heat and excess sweating
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7
Q

define Grave’s disease

A

this is an AI with antibodies to the TSH receptor, thyroid peroxisomes and thyroglobulin

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8
Q

who is Grave’s disease more common in>?

A

women 20-40/50

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9
Q

presentation of Grave’s

A
  • hyperthyroidism with diffuse enlargement of the thyroid
  • bruit over large goitre (hypervascularity)
  • eye disease (smoking) e.g. exophthalmos (fibroblasts expressing TSH receptor). TRAb driven pathology
  • pretibial myxoedema- orange peel
  • clubbing (thyroid acropachy)
    BUZZWORDS= eye change, gritty eyes and smooth velvety skin
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10
Q

eye disease management in graves

A 
mild= topical lubricants
severe= steroids, radiotherapy and surgery
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11
Q

diagnosis of Grave’s

A
  • low TSH and high T3/4
  • autoantibodies e.g. thyroid stimulating immunoglobulin, thyroid growth stimulating immunoglobulin
  • TSH binding inhibitor immunoglobulins (episodes of hypofunction)
  • TSH receptor antibody (TRAb)
  • other antibodies e.g. anti-TPO and anti-Tg
  • hypercalcaemia and high ALK (increased bone turnover and associated osteoporosis)
  • leukopenia, often related to treatment (ATD-induced agranulocytosis)
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12
Q

mechanism of management for Grave’s disease

A

block TPO thyroid hormone synthesis

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13
Q

management of Grave’s

A
  • carbimazole
  • propylthiouracil (PTU) only 1st line in first trimester (10x less potent than carbimazole
  • beta blockers for symptomatic management (first line propranolol)
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14
Q

mechanism of action of PTU

A

inhibits DIO1 which lowers T4 to T3 conversion

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15
Q

adverse of carbimazole

A

aplasia cutis in early pregnancy

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16
Q

adverse of PTU

A

liver failure

17
Q

risks in ATDs?

A

generally well-tolerated but some have allergic reaction, liver problems and risk of agranulocytosis (if this happens ATDs cannot be used again- risk highest in first 6 weeks, no evidence for monitoring FBC)

18
Q

when to stop ATDs

A

stop if fever, oral ulcer or oropharyngeal infection

19
Q

management for relapsed Grave’s and nodular thyroid disease

A

radioiodine

20
Q

if managing with radioiodine with eye disease what must be used?

A

steroid cover

21
Q

risks in RAI

A

hypothyroidism

22
Q

when is thyroidectomy used?

A

when RAI is contraindicated

23
Q

surgical risks of thyroidectomy

A

recurrent laryngeal nerve palsy
hypothyroidism
hypoparathyroidism

24
Q

define thyroid storm (crisis)

A

this is a medical emergency due to hyperthyroidism

25
Q

presentation of thyroid storm

A

respiratory and cardiac collapse
hyperthermia
exaggerated reflex

26
Q

management of thyroid storm

A 
mechanical ventilation
lugol's iodine
glucocorticoids
PTU
beta blockers
fluids
27
Q

who is thyroid storm typically seen in?

A

hyperthyroid patients with acute infection/illness or recent thyroid surgery

28
Q

who is nodular thyroid disease seen in?

A

older patient

29
Q

nodular thyroid disease presentation

A

insidious onset
thyroid may feel nodular
asymmetrical goitre (smooth in Grave’s)

30
Q

diagnosis of nodular thyroid disease

A

high T4/3 and low TSH
antibody negative (TRAb)
scintigraphy: high uptake
thyroid US

31
Q

toxic multinodular disease

A

second most common cause of hyperthyroidism
nodules can be large or barely palpable
common in areas with iodine deficiency

Endocrine: The Thyroid (15 decks)

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