Thyroid

Question 1

Thyroid hormones

Answer 1

the amount of circulating thyroid hormone is regulated by a negative feedback loop

Question 2

High levels of T3 and T4,

Answer 2

Suppress the function and production of TSH or TRH- thyrotropin -releasing hormone produced by the hypothalamus = inhibit their own production

Question 3

Hyperthyroidism:

Answer 3

High t3 and t4 and low tsh

Question 4

Hyperthyroidism - Signs and symptoms include:

Answer 4

• Increased metabolism and activity
  
  • Hyperactivity
  • insomnia
  • Heat intolerance
  • Increased appetite
  • Weight loss
  • Diarrhoea
  • Goitre

Question 5

Treatment - first line for hyperthyroidism

Answer 5

Carbimazole

Question 6

Carbimazole- MHRA Guidance

Answer 6

• Neutropenia and agranulocytosis - report sore throat,malaise,fever
  
  • Congenital malformations - women use contraception during treatment
  • Acute pancretitis - report and stop immediately if develops signs

Question 7

Propylthiouracil

Answer 7

patients should be cautious of liver disorder - jaundice,dark urine,nausea
Beta- blockers can be used to help with symptom relief

Question 8

Graves’ disease - Radioactive iodine
Carbon and blocks of Lego

Answer 8

• If remission likely to be achieved with an anti- thyroids, can consider consider carbimazole
  
  • Use carbimazole if iodine or surgery in not suitable
  • Given as a block and replace regimen in combo with levothyroxine for 12-18 months

Question 9

Pregnancy

Answer 9

• 1st trimester - propylthiouracil(due to carbimazole’s congenital defects)
  
  • 2nd and 3rd trimester - carbimazole (due to propylthiouracil’s hepatoxicity)

Question 10

Hypothyroidism:

Answer 10

Low T3 +T4 HIGH TSH

Question 11

Hypothyroidism se

Answer 11

Decreased metabolism and activity
- Fatigue, weight gain,constipation,depression,dry skin,intolerance to cold,menstural irregularities

Question 12

First line- hypothyroidism - HOW often do you monitor??

Answer 12

levothyroxine
Monitor TSH: every 3 months until stable, then yearly thereafter
Take medicine in the morning, at least 30 minutes before having breakfast or caffeinated drinks
MHRA - New guidance that a small proportion of patients can feel symptoms if alternating between brands

Question 13

Liothyronine

Answer 13

• More rapid and potent output (20-25mcg=100mcg of levothyroxine)
  
  • Non-uk brands may not be bio equivalent