Hyperthyroidsm

Question 1

What is Graves’s Disease

Answer 1

An autoimmune condition where antibodies are produced that bind to TSH receptors on the thyroid gland causing a rise in hyperthyroidism and smooth goitre

Question 2

Symptoms of Grave’s

Answer 2

Exophthalmos
Pretibial myxedema
Nervousness, excitability, restlessness
Tachycardia
Heat intolerance
Tremor
Diarrhoea
Oligo/Amenorrhoea

Question 3

What causes exophthalmos?

Answer 3

Antibodies are produced that bind to muscles behind the eye
In extreme cases can lead to blindness

Question 4

What causes pretibial myxedema?

Answer 4

Growth of soft tissue and swelling of the shins

Question 5

Describe the appearance of the goitre in Graves’

Answer 5

It is a diffuse goitre and uniform radioiodine uptake

Question 6

What is Plummers Disease and what is it also known as?

Answer 6

A benign adenoma that is overactive and releases thyroxine
Non autoimmune, don’t experience exophthalmos or pretibial myxedema
Known as toxic modular goitre

Question 7

What are the effects of thyroxine in the SNS?

Answer 7

It sensitises the beta adrenoreceptors to ambient levels of adrenaline/noradrenaline
Too much causes lid lag, tachycardia, tremor

Question 8

What are features of a thyroid storm?

Answer 8

Frank delirium
Hyperprexia
Increased tachycardia/arrhythmia
Cardiac failure
Hepatocellular dysfunction - jaundice

Question 9

4 drug classes used to treat hyperthyroidism

Answer 9

Thionamides
Beta-blockers
Potassium Iodide
Radioiodine

Question 10

Examples of thionamides and how they work

Answer 10

Propylthiouracil (PTU)
Carbimazole (CBZ)
They inhibit thyroid peroxidase so lesss T3/4 released

Question 11

Distinguish between the time taken to see biochemical and clinical effects of thionamides

Answer 11

Biochemical effect - hours
Clinical effect - weeks because there are so many thyroxine stores; beta blockers can achieve the effects in the interim

Question 12

Side effects of thionamides

Answer 12

Agranulocytosis & Rashes
When patient presents with a sore throat rather need immediate attention

Question 13

Explain the use of KI

Answer 13

When KI is administered, there is the wolf-chaikoff effect, where the iodination of thrpyroglobulin is inhibited
HOWEVER, beyond 10 days the synthesis of T4 is stimulated again

Question 14

In which context is KI given?

Answer 14

Prior to thyroid surgery

Question 15

What are some issues with surgery?

Answer 15

Risk of voice changing if recurrent laryngeal nerve is touched
Risks of losing parathyroid glands
Scar
Anaesthetics

Question 16

What is radioidone used for?

Answer 16

It us used in scans of the thyroid, it’s not a treatment

Question 17

What are the implications of using radioiodine?

Answer 17

It’s contraindicated in pregnancy
Should avoid women with children and children
Patient becomes radioactive for 2 weeks

Question 18

Medical name for inflammation of thyroid gland caused by viral infection?

Answer 18

Viral (de quervain’s) thyroiditis

Question 19

Symptoms of viral thyroiditis?

Answer 19

Painful dysphagia
Pyrexia
Hyperthyroidism
Thyroid inflammation

Question 20

Describe the progression of viral thyroiditis

Answer 20

Virus attacks thyroid glands and all T4 stores are released so patient becomes hyperthyroid and TSH drops - 1 month
T4 stores are exhausted so patient becomes hypothyroid - month 2
From this point onwards the patient slowly recovers and becomes euthyroid

Question 21

Describe the radioiodine scan of a viral thyroiditis patient

Answer 21

No radioiodine uptake

Question 22

Distinguish between viral thyroiditis and post-partum thyroiditis

Answer 22

Viral thyroiditis is painful
PPT doesn’t have pain and only occurs after pregnancy