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Year Two - Endocrine System > Hyperthyroidism > Flashcards

Hyperthyroidism Flashcards

1
Q

What is hyperthyroidism?

A

A condition in which there is overproduction of the thyroid hormone by the thyroid gland

This results in elevated levels of T3 and T4 and suppressed levels of TSH

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2
Q

What are the three general causes of hyperthyroidism?

A

Primary hyperthyroidism

Secondary hyperthyroidism

Thyrotoxicosis

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3
Q

What is primary hyperthyroidism?

A

It is hyperthyroidism resulting from a dysfunction within the thyroid gland

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4
Q

What are the three causes of primary hyperthyroidism?

A

Grave’s Disease

Toxic Multinodular Goitre

Toxic Adenoma

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5
Q

What is the most common cause of hyperthyroidism?

A

Grave’s disease

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6
Q

What is Grave’s disease?

A

It is an autoimmune condition in which TSH receptor antibodies are produced by the immune system and mimic the actions of TSH, thus stimulating the TSH receptors on the thyroid

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7
Q

What are the two risk factors of Grave’s disease?

A

Female Gender

Smoking

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8
Q

What are the four specific clinical features of Grave’s disease?

A

Exophthalmos

Ophthalmoplegia

Pretibial Myxoedema

Thyroid Acropachy

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9
Q

What is exophthalmos?

A

It is the term used to describe bulging of the eyeball out of the socket

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10
Q

What is pretibial myxoedema?

A

It is a dermatological condition in which there are deposits of mucin under the skin on the pre-tibial area

This results in shiny, orange-peel like skin on the shins

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11
Q

How does pretibial myoexedema present?

A

A discoloured, waxy, oedematous appearance to the skin over the pretibial area

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12
Q

What is thyroid acropachy?

A

It is a triad of finger clubbing, soft tissue swelling of the hands and feet and periosteal new bone formation

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13
Q

What goitre is associated with Grave’s disease?

A

Painless, smooth

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14
Q

What is another name for toxic multinodular goitre?

A

Plummer’s disease

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15
Q

What is the second most common cause of primary hyperthyroidism?

A

Toxic multinodular goitre

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16
Q

What is toxic multinodular goitre?

A

A condition in which multiple firm nodules develop on the thyroid gland that act independently of the normal feedback system and continuously produce excessive thyroid hormone

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17
Q

What goitre is associated with toxic multinodular goitre?

A

Rough

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18
Q

How does toxic multinodular goitre present on radioiodine uptake tests?

A

A patchy uptake

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19
Q

How do we manage hyperthyroidism related to toxic multinodular goitre?

A

Radioiodine therapy

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20
Q

What is toxic adenoma?

A

A singular nodule that grows on the thyroid gland causing it to become enlarged and produce excess thyroid hormones

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21
Q

How do we manage hyperthyroidism related to toxic adenoma?

A

The surgical removal of the nodule

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22
Q

What is secondary hyperthyroidism?

A

It is hyperthyroidism resulting from dysfunction within either the pituitary gland or the hypothalamus

This dysfunction results in an overstimulation of TSH

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23
Q

What is the cause of secondary hyperthyroidism?

A

Pituitary adenoma

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24
Q

What is a pituitary adenoma?

A

A singular nodule that grows on the pituitary gland

If this nodule secretes TSH, then hyperthyroidism can result

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25
What is thyrotoxicosis?
it is is characterised by the clinical manifestations of inappropriately high thyroid hormone action in tissues
26
What are the three causes of thyrotoxicosis?
De Quervain’s Thyroiditis Destructive Thyroiditis Excessive Thyroxine Administration
27
What is another term for De Quervain's thyroiditis?
Subacute thyroiditis
28
What is De Quervain’s thyroiditis?
A painful swelling of the thyroid gland thought to be triggered by a viral infection
29
De Quervain's thyroiditis consists of how many phases?
Four
30
What is the first phase of De Quervain's thyroiditis? How long does it last for?
It results in hyperthyroidism, painful goitre, raised ESR levels 3 - 6 weeks
31
What is the second phase of De Quervain's thyroiditis? How long does it last for?
It results in euthyroid 1 - 3 weeks
32
What is the third phase of De Quervain's thyroiditis? How long does it last for?
It results in hypothyroidism Weeks to months
33
What is the fourth phase of De Quervain's thyroiditis?
The thyroid structure and function goes back to normal
34
How does De Quervain's thyroiditis present on radioactive uptake tests?
A globally reduced uptake of iodine-131
35
How do we manage hyperthyroidism related to De Quervain's thyroiditis?
It is a self-limiting condition Therefore, we simply prescribe NSAIDs for symptomatic relief
36
How do we manage severe hyperthyroidism related to De Quervain's thyroiditis?
Corticosteroids
37
What is destructive thyroiditis?
It is a condition in which inflammation of the thyroid causes thyroid cell damage and destruction This results in thyroid hormones stored in the gland leaking out and increasing thyroid hormone levels in the blood
38
What are the three causes of destructive thyroiditis?
Post-Partum Viral Infections Drugs
39
How do we manage post-partum related hyperthyroidism?
It is treated with beta blockers only - there is no need for anti-thyroid drugs due to the thyroid not being overactive
40
What drug is associated with destructive thyroiditis?
Amiodarone
41
What are the two classification of amiodarone induced hyperthyroidism?
Type One Amiodarone Induced Hyperthyroidism Type Two Amiodarone Induced Hyperthyroidism
42
What is the pathophysiology of type one amiodarone induced hyperthyroidism?
It is caused by excess iodine induced thyroid hormone synthesis
43
Is goitre associated with type one amiodarone induced hyperthyroidism?
Yes
44
How do we manage type one amiodarone induced hyperthyroidism?
It is managed with carbimazole or potassium perchlorate
45
What is the pathophysiology of type two amiodarone induced hyperthyroidism?
It is caused by amiodarone related destructive thyroiditis
46
Is goitre associated with type two amiodarone induced hyperthyroidism?
No
47
How do we manage type two amiodarone induced hyperthyroidism?
Corticosteroids
48
What are the ten clinical features of hyperthyroidism?
Weight Loss Heat Intolerance & Sweating Anxiety Tremor Tachycardia Palpitations High Output Heart Failure Diarrhoea Oligomenorrhea Amenorrhoea
49
What are the three investigations used to diagnose hyperthyroidism?
Bloods Tests Radioiodine Uptake Test Thyroid Ultrasound
50
What five blood test results indicate hyperthyroidism?
Increased T3 Levels Increased T4 Levels Decreased TSH Levels TSH Receptor Stimulating Antibody Positive Anti-Thyroid Peroxidase Antibody Positive
51
What is a radioiodine uptake test?
It involves the patient consuming a small dose of radioactive iodine and measuring the uptake by the thyroid gland
52
What radio iodine uptake test result indicates Grave's disease?
A diffuse, homogenous, increased uptake
53
What is indicated when hyperthyroidism is associated with a decreased radioiodine uptake level?
Destructive thyroiditis
54
What is a feature of hyperthyroidism on ultrasound scans?
Thyroid nodules
55
What are the three pharmacological management options of hyperthyroidism?
Carbimazole Propylthiouracil Betablockers
56
What is the first line pharmacological management option of hyperthyroidism?
Carbimazole
57
What is the mechanism of action of carbimazole?
It blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin, thus reducing thyroid hormone production
58
What are the two side effects of carbimazole?
Agranulocytosis Rash
59
What is agranulocytosis?
Decreased WCC levels
60
What advice should be given to individuals adminsitered carbimazole? Why?
They should attend for ugent medical review if they develop any features of infection This is due to the side effect of agranulocytosis
61
What is the second line pharmacological management option of hyperthyroidism?
Propylthiouracil
62
When is propylthiouracil recommended to manage hyperthyroidism?
It is only recommended in pregnant patients and in those who are unable to tolerate carbimazole – due its risk of severe hepatic reactions
63
When are beta-blockers used to manage hyperthyroidism?
They are administered on initial diagnosis to relieve adrenalin-related clinical features – such as tachycardia, palpitations and tremor
64
Name a beta-blocker used to manage hyperthyroidism
Propanolol
65
What is the second line treatment option for hyperthyroidism?
Radioiodine treatment
66
What is radioactive iodine treatment?
It involves the patient consuming a small dose of radioactive iodine, which the thyroid gland then uptakes This results in radiation emission, which destroys a portion of thyroid cells, leading to decreased thyroid hormone production
67
What do we do if patients are taking anti-thyroid medications prior to radioiodine treatment?
We advise individuals to stop the medication four to seven days before and after treatment
68
What is thyroidectomy?
It involves surgical removal of the whole thyroid gland or toxic nodules
69
What are the five complications of thyroidectomy?
Hypothyroidism Hypocalcaemia Hypoparathyroidism Vocal Cord Damage Confined Haematoma
70
In cases where hypocalacaemia develops following thyroid surgery, what is the feature present on ECG?
Isolated QTc elongation
71
How do we prevent complications arising during thyroidectomy?
They are prescribed potassium iodide before surgery This decreases thyroid gland vascularity
72
What is a complication of hyperthyroidism?
Thyroid storm
73
What is another term for thyroid storm?
Thyrotoxic crisis
74
What is a thyroid storm?
It is a rare life-threatening complication of hyperthyroidism
75
When do thyroid storms usually present?
It usually presents in those with established thyrotoxicosis and is rarely seen as the presenting feature
76
What are the four causes of a thyroid storm?
Thyroid Surgery Trauma Infection Acute Iodine Load
77
What are the seven clinical features of thyroid storm?
Fever > 38.5 Nausea & Vomiting Tachycardia Hypertension Heart Failure Jaundice Confusion
78
What are the five management options of a thyroid storm?
Underlying Aetiology Management Beta-Blockers Anti-Thyroid Medications Dexamethasone Lugol’s Iodine
79
Name a beta blocker used to manage thyroid storms
IV propanolol
80
Name two anti-thyroid medications used to manage thyroid storms
Methimazole Propylthiouracil
81
What dose of dexamethasone is used to manage thyroid storms?
IV 4mg
82
What is subclinical hyperthyroidism?
It is defined as a condition in which TSH levels are suppressed < 0.1 mu/l, however the free serum thyroxine and triiodothyronine levels are normal
83
What is the pathophysiology of subclinical hyperthyroidism?
The thyroxine hormone levels are at the upper range of normal, resulting in a decreased secretion of TSH to suppress this
84
What are the two causes of subclinical hyperthyroidism?
Multinodular Goitre Excessive Thyroxine Administration
85
What is the conservative management option of subclinical hyperthyroidism?
We conduct TFTs everry 6 months In cases where TSH levels stabilise and there are two similar measureemnts within the reference range 3 -6 months apart, TSH measurements can be stopped
86
What is the pharmacological management option of subclinical hyperthyroidism?
Low dose anti-thyroid medications for a period of six months
87
When is pharmacological management of hyperthyroidism recommended?
In cases where patients are symptomatic or present with goitre
88
What are the two complications of subclinical hyperthyroidism?
Osteoporosis Atrial Fibrillation

Year Two - Endocrine System (17 decks)

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