Hyperthyroidism Flashcards
What is the most common cause of hyperthyrodisim?
Grave’s disease - autoimmune disease
What causes Grave’s disease?
IgG against TSH receptors on follicular cells mimic TSH
Causes increase in T3 and T4
What gender is hyperthyroidism more common in?
Females
Thyroid hormones activate the sympathetic nervous system and increase BMR. Based on this, what symptoms are present in the following systems:
- Cardiac
- GI
- CNS
- MSK
- Reproductive
- Heat tolerance
Cardiac
- Increased HR
- Palpitations/AF
GI
- increased bowel movements + loose movements
CNS
- anxiety
- nervousness
- sleep disturbances
- irritability
MSK
- muscle weakness
- tremor
Reproductive
- lighter/infrequent periods
Heat tolerance
- sweating
- intolerance to heat
Why must Grave’s patients be so actively encouraged to stop smoking?
Smoking increases the risk of ophthalmopathy
What eye and skin condition is unique to Grave’s?
Eye
= exophthalmos - eyes bulging (due to hypertrophy of muscles behind eye - mediated by anti-TSH receptor antibodies)
Skin
= pretibial myxoedema (mucin deposits underneath the skin on fronts of the lower leg - discoloured, waxy, oedematous appearance to front of legs)
How is hyperthyroidism managed via drugs?
(whilst waiting to get seen by specialist) Symptomatic relief - beta blockers - propranolol
Anti-thyroid drugs
1. CARBIMAZOLE
What is the MoA of anti-thyroid drugs?
They block TPO (an enzyme which causes iodination of thyroglobulin) -> decreased T3 and T4
How long does treatment take in Grave’s disease?
12-18mths of drug titration (maintain normal levels of T3 + T4)
OR
6mnths of ‘block and replace’ (completely block thyroid hormones and replace with levothyroxine)
What is the side effect of anti-thyroid drugs that MUST be told to patients?
What safety netting must be told?
Agranulocytosis -> (can potentially be fatal)
If get feverish or ill go to doctor straight away
What is the first line treatment for relapsed Grave’s disease (50% of cases) and multinodular disease?
In what type of patient is this contradicted?
Radioactive iodine (swallowing)
Pregnant/~those with active eye problems
Compare the age and examination of goitre in patients presenting with Grave’s disease and toxic multinodular goitre?
Grave’s
- 20-50 yo
- diffuse, smooth goitre
Toxic multinodular goitre
- > 50yo
- can feel hard nodules in thyroid
What is the other name for toxic multinodular goitre?
What is the first line treatment for this disease?
What other condition is this also first line for?
Plummer’s disease
Radioactive iodine
Relapsed Grave’s
De Quervain’s Thyroiditis can result in hyperthyroiditis alongside fever, neck pain, DYSPHAGIA and general malaise.
How is it treated?
Self-limiting caused by viral infection
NSAIDS and B-blockers for symptomatic relief
What is the medical emergency associated with hyperthyroidism?
How does it present?
How is it managed?
Thyroid storm
Resp and cardiac arrest
Hyperthermia
Mental status change
Carbimazole - high dose
Beta-blockers
Fluids
