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Junior Medicine- Endocrine > Hyperthyroidism > Flashcards

Hyperthyroidism Flashcards

1
Q

What is hyperthyroidism?

A

Over-production of thyroid hormone by the thyroid gland.

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2
Q

What is thyrotoxicosis?

A

Excessive quantity of thyroid hormone in circulation.

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3
Q

What is primary hyperthyroidism?

A

Thyroid itself produces excessive thyroid hormone.

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4
Q

What is secondary hyperthyroidism?

A

Excessive stimulation of the thyroid by the hypothalamus or pituitary.

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5
Q

What stimulates thyroid hormone synthesis?

A

TSH

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6
Q

Outline thyroid hormone synthesis.

A
  • Tyrosine have 1 or 2 Iodides (iodination)
  • Two tyrosines bind on the surface of a thyroglobulin (coupling)
  • T3 and T4 made
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7
Q

Which thyroid hormone is mostly produced? What happens in circulation?

A

T4

Converted to T3

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8
Q

Which thyroid hormone is most metabolically active?

A

T3

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9
Q

Which enzyme powers thyroid hormone synthesis?

A

Thyroid peroxidase

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10
Q

What are thyroid follicles?

A

Thyroid follicle cells arranged into spheres, with a colloid centre

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11
Q

What is the most common cause of hyperthyroidism?

A

Grave’s

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12
Q

What is Grave’s disease?

A

Autoimmune- TSH Receptor antibodies, mimicking TSH to stimulate the thyroid.

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13
Q

What type of hyperthyroidism is Grave’s?

A

Primary hyperthyroidism

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14
Q

What is toxic multi-nodular goitre?

A

Nodules develop on the thyroid gland, acting independently to the feedback system.

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15
Q

What is toxic multinodular goitre also called?

A

Plummer’s Disease

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16
Q

What is exophthalmos?

A

Bulging of the eyes caused by Grave’s

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17
Q

Describe how exophthalmos occurs.

A

Inflammation behind the eye, with swelling of the tissue pushing the eyes forward.

18
Q

What is pretibial myxoedema?

A

Mucin deposits under the skin of the anterior leg

19
Q

What does pretibial myxoedema look like?

A

Waxy, oedematous skin, discoloured

20
Q

What causes pre-tibial myxoedema and why?

A

Grave’s- reaction to TSH receptor antibodies.

21
Q

What are the generic symptoms of hyperthyroidism?

A
  • Irritable/Anxious
  • Weight Loss
  • Heat intolerance/Sweating
  • Fatigue
  • Tachy
  • Loose stools
  • Sexual dysfunction
22
Q

What are the added symptoms in Grave’s?

A

Goitre

Exophthalmos

Pretibial myxoedema

23
Q

What are the added symptoms in toxic multinodular goitre?

A

Goitre with nodules

24
Q

What is a solitary toxic thyroid nodule?

A

Hyperthyroidism caused by one single nodule, usually a benign adenoma

25
Q

What is De Quervain’s Thyroiditis?

How is it treated?

A

Viral infection causes hyperthyroidism, then hypothyroidism

NSAIDs for analgesia and beta blockers for symptom relief

26
Q

How does De Quervain’s Thyroiditis present?

A
  • Viral infection
  • Fever
  • Neck pain
  • Dysphagia
  • Hyperthyroid features
27
Q

Why does De Quervain’s Thyroiditis eventually cause hypothyroidism?

A

Negative feedback

28
Q

What is thyroid storm?

A

Hyperthyroidism with pyrexia and delirium

29
Q

What is the first line treatment of hyperthyroidism?

A

Carbimazole

30
Q

How does carbimazole work?

A

Decreases iodine uptake to the thyroid

31
Q

How quickly does carbimazole work?

A

4-8 weeks

32
Q

What options are there after carbimazole is successful?

A
  1. Titrated to maintain normal thyroid hormone levels

2. Completely inhibit thyroid production and treat with levothyroxine

33
Q

When is carbimazole stopped?

A

Usually within 18 months

34
Q

What is the second line drug in hyperthyroidism?

A

Propylthiouracil

35
Q

Why isn’t propylthiouracil commonly used in hyperthyroidism?

A

Risk of severe hepatic reactions and death

36
Q

How does radioactive iodine work in hyperthyroidism?

A

Taken up by the thyroid where the radiation destroys thyroid follicle cells

37
Q

What can occur after radioactive iodine treatment and how is this treated?

A

Hypothyroidism- treat with levothyroxine

38
Q

What are the rules of radioactive iodine use?

A
  • Must not become pregnant within 6 months
  • Must avoid contact with children and pregnant women for 3 weeks
  • Must limit any social contact for several days after receiving a dose
39
Q

Why are beta blockers used in hyperthyroidism?

A
  1. Thyroid hormones promote adrenaline release
  2. Beta blockers blocks adrenergic activity
  3. Symptoms controlled
40
Q

Which beta-blocker is used in hyperthyroidism and why?

A

Propanolol

It’s non-selective unlike others, which only work on the heart

41
Q

How is surgery used?

A
  • Either the thyroid entirely or just nodules can be removed

- Treat with lifelong levothyroxine afterwards

42
Q

What are the complications of hyperthyroidism?

A
  • Exopthalmos/Pre-tibial myxoedema
  • Hypothyroidism from treatment
  • Miscarriage and Pre-eclampsia
  • Tachy-Arrythmias

Junior Medicine- Endocrine (10 decks)

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