Hyperthyroidism/Thyrotoxicosis Flashcards
what is hyperthyroidism
refers specifically to conditions in which overactivity of the thyroid gland leads to thyrotoxicosis
what is thyrotoxicosis
the clinical, physiological and biochemical state arising when the tissues are exposed to excess thyroid hormone
what cardiac signs/symptoms are associated with thyrotoxicosis
palpitation, AF, cardiac failure(very rare)
what sympathetic and CNS signs/symptoms are associated with thyrotoxicosis
sympathetic = sweating, tremor CNS = anxiety, nervousness, irritability, sleep disturbance
what GI signs/symptoms are associated with thyrotoxicosis
frequent and loose bowel movements
what vision signs/symptoms are associated with thyrotoxicosis
lid retraction(not specific to Graves), double vision, proptosis(Graves)
what hair/skin changes are associated with thyrotoxicosis
hair change to brittle and thin hair, rapid fingernail growth
what reproductive and muscle signs/symptoms are associated with thyrotoxicosis
reproductive = menstrual cycle changes, eg lighter bleeding and less frequent periods muscles = muscles weakness, esp. upper arms and thighs
what metabolic and thermogenesis signs/symptoms are associated with thyrotoxicosis
metabolic = weight loss despite increased appetite thermogenesis = intolerance to heat
what conditions cause hyperthyroidism/thyrotoxicosis as a result of excessive thyroid stimulation
Graves disease, Hashitoxicosis, thyrotropinoma, thyroid cancer, choriocarcinoma
what conditions cause hyperthyroidism/thyrotoxicosis as a result of thyroid nodules with autonomous function
toxic solitary nodule and toxic multinodular goitre
what changes in T3, T4 and TSH are seen in primary and secondary hyperthyroidism
primary = high free T3 + T4, low TSH secondary = increased T3 + T4, high or normal TSH
what is pretibial myxoedema
rare clinical sign specific to Graves’ disease, results in an infiltrative dermopathy
what different types of conditions can cause thyrotoxicosis that are NOT associated with hyperthyroidism
thyroiditis, exogenous thyroid hormone, ectopic thyroid tissue
give 2 examples of thyroiditis that can cause thyrotoxicosis that are NOT associated with hyperthyroidism
subacute(de Quervain’s) thyroiditis, post-partum thyroiditis
when does Graves’ disease usually present and what precipitating factors are there
young(20-50y/o), interacting susceptibility genes 70% of cause, rest environmental such as smoking
what clinical signs are specific to Graves’ disease
thyroid acropachy, thyroid bruit, Graves eye disease(ie Graves opthalmopathy)
what is the most common cause of hyperthyroidism
Graves disease(85%)
describe the characteristics/onset of nodular thyroid disease
older patients, insidious onset, thyroid may feel nodular, asymmetrical goitre(smooth in Graves)
what tests can be done for nodular thyroid disease
high free T3 and T4, low TSH, antibody negative(TRAb) and scintigraphy = high uptake
what thyroid autoantibodies are seen in Graves disease
anti-TPO antibody(70-80%), auto-thyroglobulin antibody(30-50%), TSH receptor antibody(70-100%)
what clinical features are seen in a thyroid storm
severe hyperthyroidism, resp and cardiac collapse, hyperthermia
(medical emergency)
in what patients is a thyroid storm typically seen in
hyperthyroid patients with an acute infection/illness or recent thyroid surgery
what treatment is used for a thyroid storm
Lugol’s iodine, glucocorticoids, PTU, beta-blockers, fluids, monitoring
what is the triad of typical clinical signs seen in Graves’ disease
hyperthyroidism with diffuse enlargement of thyroid gland, ophthalmology, pretibial myxoedema
