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TCA 7 - Thyroid Disease > Hyperthyroidism > Flashcards

Hyperthyroidism Flashcards

1
Q

What is hyperthyroidism?

A

Increased thyroid hormone synthesis and secretion from the thyroid gland

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2
Q

What is thyrotoxicosis?

A

The clinical syndrome of excess circulating thyroid hormones

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3
Q

What is the most common cause of hyperthyroidism?

A

Grave’s disease

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4
Q

What is the 2nd most common cause of hyperthyroidism?

A

Multinodular goitre

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5
Q

What is the 3rd most common cause of hyperthyroidism?

A

Solitary toxic nodule

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6
Q

What are the causes of hyperthyroidism

A
  • Grave’s disease
  • Multinodular goitre
  • Solitary toxic nodule
  • Drugs
    Interferon, amiodarone
  • Acute thyroiditis
  • Gestational thyrotoxicosis
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7
Q

What causes Grave’s disease?

A

Autoimmune process that causes Antibody stimulation of TSH receptor

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8
Q

What is the most common cause of hyperthyroidism in the younger population?

A

Grave’s disease

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9
Q

What are the risk factors for Grave’s disease?

A
  • Females
  • +ve family Hx
  • Smoking
  • Low iodine intake
  • Other autoimmune diseases
  • T1DM
  • Pernicious anaemia
  • Coeliac
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10
Q

How may Grave’s disease present?

A

Diffusely symmetrical enlarged thyroid gland without nodules, and there may be a bruit

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11
Q

What is a multinodular goitre?

A

Multiple thyroid nodules that become independent of TSH regulation

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12
Q

What is the most common cause of hyperthyroidism in the older population?

A

Mulinodular goitre

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13
Q

How may multinodular goitre present?

A

Non-tender, firm thyroid nodules

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14
Q

What is solitary toxic nodule?

A

Solitary benign adenoma

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15
Q

How may solitary toxic nodule present?

A

Unilateral, non-tender thyroid mass

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16
Q

What is acute thyroiditis?

A

Inflammation of the thyroid gland which leads to release of thyroid hormones

17
Q

What symptoms are associated with acute thyroiditis?

A
  • Fever
  • Neck pain
  • Tenderness
  • Dysphagia
18
Q

How may acute thyroiditis present?

A

Tender, firm, irregular, diffusely enlarged thyroid gland which may be asymmetrical

19
Q

How does gestational thyrotoxicosis occur?

A

High concentrations of hCG can stimulate TSH receptors and suppress TSH

20
Q

When does gestational thyrotoxicosis occur?

A

1st Trimester

21
Q

What are the universal symptoms of hyperthyroidism?

A
  • Anxiety and agitation
  • Sweating
  • Heat intolerance
  • Tachycardia
  • Weight loss despite good appetite
  • Loss of libido
  • Diarrhoea
  • Fatigue
22
Q

What are the universal signs of hyperthyroidism?

A
  • Palmar erythema
  • Fine tremor
  • Oncholysis
  • Proximal myopathy
  • Hyperreflexia
  • Eyelid retraction
  • Lid lag
23
Q

What are the signs only seen in Grave’s disease?

A
  • Acropachy
  • Pretibial myxoedema
  • Eye disease:
    Proptosis/exophthalmos
    Ophthalmoplegia
    Oedema
    Double vision
24
Q

What is acropachy?

A

Soft tissue swelling of the hands and clubbing of the fingers

25
Q

What is pretibial myxoedema?

A

o Deposits of mucin under the skin in the pretibial area

o Discoloured, waxy, oedematous appearance to the skin

26
Q

What is Proptosis/exophthalmos?

A

Protrusion of eyeball

27
Q

What is eyelid retraction?

A

Sclera is visible above the superior corneal limbus

28
Q

What is the main risk factor of thyroid eye disease?

A

Smoking

29
Q

How do you treat thyroid eye disease?

A
  • Steroids
  • Immunosuppression
  • Surgery
30
Q

What additional test would you order for Grave’s disease?

A

TRAbs (TSH-receptor antibodies)

31
Q

What additional test would you order for thyroiditis?

A

ESR and CRP

32
Q

How do you treat hyperthyroidism?

A
  • Propanolol
  • Antithyroid drugs = Carbimazole (1st), Propylthiouracil (2nd)

Others:

  • Radioactive iodine
  • Thyroidectomy
33
Q

How can you give antithyroid drugs?

A
  • Titration = start with high dose, and lower dose until lowest one is most effective
  • Block-replace = High dose of antithyroid drug until hypothyroidism, then you give levothyroxine as a replacement
34
Q

What do you need to warn a patient of when taking antithyroid meds?

A

• Agranulocytosis

  • Report signs of infection, especially a sore throat
  • WBC count should be performed
  • Drug stopped if evidence of neutropenia
35
Q

What can cause neonatal hyperthyroidism?

A

In Graves’ disease, thyroid stimulating antibodies can cross the placenta and stimulate the thyroid gland of the foetus

36
Q

What is a thyrotoxic crisis/ thyroid storm?

A

End of the spectrum of thyrotoxicosis and is characterised by compromised organ function

37
Q

How would you treat acute thyroiditis?

A

o Propranolol

Don’t need to give antithyroid medications

38
Q

What is type 1 amiodarone induced thyrotoxicosis (AIT)?

A
  • Excess thyroid hormone synthesis
  • Enlarged goitre
  • Managed with carbimazole or potassium perchlorate
  • Stop amiodarone
39
Q

What is type 2 amiodarone induced thyrotoxicosis (AIT)?

A
  • Amiodarone-related destructive thyroiditis
  • No Goitre
  • Corticosteroids
  • Stop amiodarone

TCA 7 - Thyroid Disease (6 decks)

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