Hyperthyroidism (+Grave's) Flashcards
What is hyperthyroidism?
The over production of thyroid hormone
What is thyrotoxicosis?
Another work for hyperthyroidism.
When theres too much thyroid hormone in the body.
What is primary hyperthyroidism?
When the thyroid gland itself produces too much thyroid hormone.
What is secondary hyperthyroidism?
When the anterior pituitary gland produces too much thyroid stimulating hormone, which causes the thyroid gland to produce too much thyroid hormone.
What is tertiary hyperthyroidism?
When the hypothalamus produces too much thyroid releasing hormone, causing the anterior pituitary to release too much thyroid stimulating hormone, causing the thyroid gland to produce too much thyroid hormone.
What are the causes of primary hyperthyroidism?
Graves disease
Toxic thyroid adenoma
Multinodular goitre
De quervains thyroiditis
What are the secondary causes of hyperthyroidism?
Lithium
TSH producing pituitary adenoma
Amiodrarone
What are general signs of hyperthyroidism?
Anxiety Weight loss despite increased appetite Tachycardia Fatigue Irritability Finger clubbing Sweating Frequent loose stools Sexual dysfunction Fine tremor Goitre Thyroid bruit Muscle wasting Atrial fibrillation
What are the signs specific to graves disease?
Exophthalmos
Pretibial myxoedema
Diffuse goutte without nodules
What is the 1st and second must common cause of hyperthyroidism?
1st - graves disease
2nd - toxic multi nodular disease
What is graves disease?
Autoimmune disorder.
Body produces TSH antibodies which bind to TSH receptors.
What is toxic multi nodular goitre?
Nodules on the thyroid which act independently from the normal feedback system, they continuously produce thyroid hormone.
What medication is used for symptomatic relief of hyperthyroidism?
Beta blocker
Propanalol - because its non selective
What is the 1st line treatment for hyperthyroidism?
Carbomazole
What is the 2nd line treatment for hyperthyroidism?
Propylthiouracil
What is titration block vs block and replace?
Titration block - patient has enough medication to bring thyroid levels down to normal
Block and replace -patient has so much medication that all thyroid hormone production is stopped and they are given levothyroxine as a replacement
What is a contraindication of Radioactive iodine?
Exophthalmos - can make it worse
What is the signs of thyroid storm?
Pyrexia
Tachycardia
Delirium
Which thyroid hormone is the effective one?
T3
What causes thyrotoxicosis?
When someone stops treatment or has surgery
What is the management for thyroid storm?
IV propanolol
IV digoxin
prednisolone
Propylthiouracil
How is radioactive iodine taken?
As a drink
Avoid everyone for a few days
Avoid pregnant women and children for 3 weeks
How long can you not get pregnant for after having RAI?
6 months
How is a solitary toxic thyroid nodule treated?
Surgical removal of the nodule
What are the signs of de quervains thyroiditis?
Viral infection" fever neck pain dysphagia hyperthyroidism
How is de quervains syndrome treated?
It is a self limiting condition:
Beta blockers - for symptomatic relief
NSAIDs
If someone has surgery, what medication should they be given?
Levothyroxine
What are some complications of hyperthyroidism?
Thyroid storm Congestive heart failure Atrial fibrillation Osteoporosis Visual loss (in graves)
What are the levels of TRH, TSH and T3/4 in primary hyperthyroidism?
TRH - normal
TSH - low
T3/4 - high
What are the levels of TRH, TSH and T3/4 in secondary hyperthyroidism?
TRH - low
TSH - high
T3/4 - high
What are the levels of TRH, TSH and T3/4 in tertiary hyperthyroidism?
TRH - high
TSH - high
T3/4 - high
