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BRS Y2 > Hyperthyroidism > Flashcards

Hyperthyroidism Flashcards

1
Q

What does TSH do?

A

Activates uptake of iodine into the thyroid follicular cell which eventually leads to formation of thyroxine

Activates proteolytic enzyme

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2
Q

How much thyroxine do we store?

A

Enough for one month

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3
Q

What enzyme allows release of thyroxine from the thyroid follicular cell? How does it do this?

A

Proteolytic enzyme- makes a hole in the cell

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4
Q

How does the negative feedback loop for thyroxine work?

A

T3 and T4 have negative feedback on the pituitary AND on the hypothalamus

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5
Q

What will TSH levels be in someone with primary hypothyroidism where the thyroid gland is destroyed?

A

High TSH

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6
Q

What does thyroxine do?

A

Increases a lot of metabolic processes

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7
Q

What is Graves disease?

A

An autoimmune condition where antibodies bind to and stimulate the TSH receptor in the thyroid causing a smooth goitre and hyperthyroidism

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8
Q

What happens to the thyroid in Graves disease?

A

Smooth goitre

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9
Q

How does Graves disease present?

A 
Exophthalmos
Sweatiness
Mostly female and young
Weight loss with increased appetite 
High pulse
Oligo/amenorrhea
Swollen ankles and shins (pretibial myxoedema) 
Tremor
Diarrhoea
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10
Q

What is Plummer’s disease? What type of condition is it? How does it differ from Grave’s symptomatically?

A

Benign toxic nodular goitre of thyroid (NOT autoimmune) that causes hyperthyroidism
NO pre-tibial myxoedema or exophthalmos

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11
Q

What are TSH, T3, T4 levels in someone with Plummer’s?

A

High T3 and T4

No TSH

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12
Q

How do we differentiate Plummer’s vs Grave’s?

A

In Plummer’s theres one large benign growth and the rest of the thyroid shrinks
In Graves the whole gland is enlarged

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13
Q

What is any non Grave’s hyperthyroidism classified as?

A

Plummer’s

aka toxic multi-nodular goitre or hot nodule

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14
Q

How does thyroxine effect the sympathetic nervous system? How does this present?

A

T3 makes beta receptors more sensitive to adrenaline /noradrenaline (doesn’t bind but makes downstream cascade faster). This causes a high heart rate whenever they try to do anything= tachycardia, palpitations, tremor, lid lag

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15
Q

What is lid lag and how do you test it?

A

Ask them to follow your finger take it really high up, to mid level and low down and if they have hyperthyroidism their eyelids will lag and stay up slightly too long due to excess adrenaline

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16
Q

What symptoms do you need to ask about when you suspect hyperthyroidism

A 
Weight loss despite increased appetite
Breathlessness
Palpitations,tachycardia
Sweating
Heat intolerance
Diarrhoea
Lid lag and other sympathetic features
17
Q

What is thyroid storm?

A 
Untreated hyperthyroidism= lots of excess thyroxine
Hyperpyrexia > 41oC
accelerated tachycardia / arrhythmia
cardiac failure
delirium / frank psychosis
hepatocellular dysfunction; jaundice
18
Q

What is treatment for a thyroid storm?

A

Urgent in hospital treatment

19
Q

What are options for treating hyperthyroidism?

A

Surgery (thyroidectomy)
Radioiodine
Drugs

20
Q

What drugs can be used for hyperthyroidism?

A

Thionamides
Potassium iodide
Radioiodine
Beta blockers (only helps with symptoms first 3 stop thyroxine synthesis)

21
Q

How do thionamides work?

A

Inhibit TPO so reduce thyroxine synthesis- takes weeks to show on blood test, so give beta blockers for first few weeks

22
Q

What are side effects of thionamides?

A

Agranulocytosis- reduction of neutrophils (get sore throats)

Rashes

23
Q

When is iodine used to treat hyperthyroidism?

A

Preparing them for surgery (quick action)

If in a thyroid storm

24
Q

Why is iodine not an ideal drug?

A

Its not for long term

25
Q

Why is iodine used in hyperthyroidism before surgery?

A

Stops the gland being vascular so it bleeds a lot less in surgery

26
Q

What is the main risk with thyroid surgery?

A

Cutting of recurrent laryngeal nerve which alters voice

27
Q

How is radioiodine taken and what precautions must you take?

A

Swallow a capsule

Stay away from pregnant people for a few days as you emit radiation

28
Q

How does viral thyroiditis present?

A

Painful dysphagia
Hyperthyroidism
Pyrexia
Thyroid inflammation

29
Q

How is viral thyroiditis diagnosed?

A

They have no iodine uptake at all (cells are too inflammed), this wouldnt happen in Graves or Plummers

30
Q

What happens long term in viral thyroiditis?

A

After a month of hyperthyroidism (all stored thyroxine is released) there is hypothyroidism as no new thyroxine has been synthesised, eventually even after that they will go back to normal (after 3 months)

BRS Y2 (85 decks)

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