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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
Q

What is thyrotoxicosis?

A

it is is characterised by the clinical manifestations of inappropriately high thyroid hormone action in tissues

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26
Q

What are the three causes of thyrotoxicosis?

A

De Quervain’s Thyroiditis

Destructive Thyroiditis

Excessive Thyroxine Administration

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27
Q

What is another term for De Quervain’s thyroiditis?

A

Subacute thyroiditis

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28
Q

What is De Quervain’s thyroiditis?

A

A painful swelling of the thyroid gland thought to be triggered by a viral infection

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29
Q

De Quervain’s thyroiditis consists of how many phases?

A

Four

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30
Q

What is the first phase of De Quervain’s thyroiditis? How long does it last for?

A

It results in hyperthyroidism, painful goitre, raised ESR levels

3 - 6 weeks

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31
Q

What is the second phase of De Quervain’s thyroiditis? How long does it last for?

A

It results in euthyroid

1 - 3 weeks

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32
Q

What is the third phase of De Quervain’s thyroiditis? How long does it last for?

A

It results in hypothyroidism

Weeks to months

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33
Q

What is the fourth phase of De Quervain’s thyroiditis?

A

The thyroid structure and function goes back to normal

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34
Q

How does De Quervain’s thyroiditis present on radioactive uptake tests?

A

A globally reduced uptake of iodine-131

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35
Q

How do we manage hyperthyroidism related to De Quervain’s thyroiditis?

A

It is a self-limiting condition

Therefore, we simply prescribe NSAIDs for symptomatic relief

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36
Q

How do we manage severe hyperthyroidism related to De Quervain’s thyroiditis?

A

Corticosteroids

37
Q

What is destructive thyroiditis?

A

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
Q

What are the three causes of destructive thyroiditis?

A

Post-Partum

Viral Infections

Drugs

39
Q

How do we manage post-partum related hyperthyroidism?

A

It is treated with beta blockers only - there is no need for anti-thyroid drugs due to the thyroid not being overactive

40
Q

What drug is associated with destructive thyroiditis?

A

Amiodarone

41
Q

What are the two classification of amiodarone induced hyperthyroidism?

A

Type One Amiodarone Induced Hyperthyroidism

Type Two Amiodarone Induced Hyperthyroidism

42
Q

What is the pathophysiology of type one amiodarone induced hyperthyroidism?

A

It is caused by excess iodine induced thyroid hormone synthesis

43
Q

Is goitre associated with type one amiodarone induced hyperthyroidism?

A

Yes

44
Q

How do we manage type one amiodarone induced hyperthyroidism?

A

It is managed with carbimazole or potassium perchlorate

45
Q

What is the pathophysiology of type two amiodarone induced hyperthyroidism?

A

It is caused by amiodarone related destructive thyroiditis

46
Q

Is goitre associated with type two amiodarone induced hyperthyroidism?

A

No

47
Q

How do we manage type two amiodarone induced hyperthyroidism?

A

Corticosteroids

48
Q

What are the ten clinical features of hyperthyroidism?

A

Weight Loss

Heat Intolerance & Sweating

Anxiety

Tremor

Tachycardia

Palpitations

High Output Heart Failure

Diarrhoea

Oligomenorrhea

Amenorrhoea

49
Q

What are the three investigations used to diagnose hyperthyroidism?

A

Bloods Tests

Radioiodine Uptake Test

Thyroid Ultrasound

50
Q

What five blood test results indicate hyperthyroidism?

A

Increased T3 Levels

Increased T4 Levels

Decreased TSH Levels

TSH Receptor Stimulating Antibody Positive

Anti-Thyroid Peroxidase Antibody Positive

51
Q

What is a radioiodine uptake test?

A

It involves the patient consuming a small dose of radioactive iodine and measuring the uptake by the thyroid gland

52
Q

What radio iodine uptake test result indicates Grave’s disease?

A

A diffuse, homogenous, increased uptake

53
Q

What is indicated when hyperthyroidism is associated with a decreased radioiodine uptake level?

A

Destructive thyroiditis

54
Q

What is a feature of hyperthyroidism on ultrasound scans?

A

Thyroid nodules

55
Q

What are the three pharmacological management options of hyperthyroidism?

A

Carbimazole

Propylthiouracil

Betablockers

56
Q

What is the first line pharmacological management option of hyperthyroidism?

A

Carbimazole

57
Q

What is the mechanism of action of carbimazole?

A

It blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin, thus reducing thyroid hormone production

58
Q

What are the two side effects of carbimazole?

A

Agranulocytosis

Rash

59
Q

What is agranulocytosis?

A

Decreased WCC levels

60
Q

What advice should be given to individuals adminsitered carbimazole? Why?

A

They should attend for ugent medical review if they develop any features of infection

This is due to the side effect of agranulocytosis

61
Q

What is the second line pharmacological management option of hyperthyroidism?

A

Propylthiouracil

62
Q

When is propylthiouracil recommended to manage hyperthyroidism?

A

It is only recommended in pregnant patients and in those who are unable to tolerate carbimazole – due its risk of severe hepatic reactions

63
Q

When are beta-blockers used to manage hyperthyroidism?

A

They are administered on initial diagnosis to relieve adrenalin-related clinical features – such as tachycardia, palpitations and tremor

64
Q

Name a beta-blocker used to manage hyperthyroidism

A

Propanolol

65
Q

What is the second line treatment option for hyperthyroidism?

A

Radioiodine treatment

66
Q

What is radioactive iodine treatment?

A

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
Q

What do we do if patients are taking anti-thyroid medications prior to radioiodine treatment?

A

We advise individuals to stop the medication four to seven days before and after treatment

68
Q

What is thyroidectomy?

A

It involves surgical removal of the whole thyroid gland or toxic nodules

69
Q

What are the five complications of thyroidectomy?

A

Hypothyroidism

Hypocalcaemia

Hypoparathyroidism

Vocal Cord Damage

Confined Haematoma

70
Q

In cases where hypocalacaemia develops following thyroid surgery, what is the feature present on ECG?

A

Isolated QTc elongation

71
Q

How do we prevent complications arising during thyroidectomy?

A

They are prescribed potassium iodide before surgery

This decreases thyroid gland vascularity

72
Q

What is a complication of hyperthyroidism?

A

Thyroid storm

73
Q

What is another term for thyroid storm?

A

Thyrotoxic crisis

74
Q

What is a thyroid storm?

A

It is a rare life-threatening complication of hyperthyroidism

75
Q

When do thyroid storms usually present?

A

It usually presents in those with established thyrotoxicosis and is rarely seen as the presenting feature

76
Q

What are the four causes of a thyroid storm?

A

Thyroid Surgery

Trauma

Infection

Acute Iodine Load

77
Q

What are the seven clinical features of thyroid storm?

A

Fever > 38.5

Nausea & Vomiting

Tachycardia

Hypertension

Heart Failure

Jaundice

Confusion

78
Q

What are the five management options of a thyroid storm?

A

Underlying Aetiology Management

Beta-Blockers

Anti-Thyroid Medications

Dexamethasone

Lugol’s Iodine

79
Q

Name a beta blocker used to manage thyroid storms

A

IV propanolol

80
Q

Name two anti-thyroid medications used to manage thyroid storms

A

Methimazole

Propylthiouracil

81
Q

What dose of dexamethasone is used to manage thyroid storms?

A

IV 4mg

82
Q

What is subclinical hyperthyroidism?

A

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
Q

What is the pathophysiology of subclinical hyperthyroidism?

A

The thyroxine hormone levels are at the upper range of normal, resulting in a decreased secretion of TSH to suppress this

84
Q

What are the two causes of subclinical hyperthyroidism?

A

Multinodular Goitre

Excessive Thyroxine Administration

85
Q

What is the conservative management option of subclinical hyperthyroidism?

A

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
Q

What is the pharmacological management option of subclinical hyperthyroidism?

A

Low dose anti-thyroid medications for a period of six months

87
Q

When is pharmacological management of hyperthyroidism recommended?

A

In cases where patients are symptomatic or present with goitre

88
Q

What are the two complications of subclinical hyperthyroidism?

A

Osteoporosis

Atrial Fibrillation

Year Two - Endocrine System (17 decks)

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