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Endocrine > Thyroid 2 > Flashcards

Thyroid 2 Flashcards

1
Q
A
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2
Q

Management of De Quervain’s thyroiditis

A
  • self-limiting condition
  • NSAIDs for pain and inflammation
  • beta- blockers - for symptomatic relief of hyperthyroidism
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3
Q

Thyroid storm

  • another name
  • what thyroid disorder it is associated with
A

Thyroid storm = thyrotoxic crisis

Associated with hyperthyroidism

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4
Q

Presenting features of thyroid storm (3)

A
  • pyrexia
  • tachycardia
  • delirium
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5
Q

Management of thyroid storm

A

thyroid storm = severe presentation of hyperthyroidism

Management:

  • admission for monitoring
  • treated the same way as any other presentation of thyrotoxicosis
  • may need supportive care with fluid resuscitation, anti-arrhythmic medication and beta blockers
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6
Q

First line drug in treatment of hyperthyroidism

A

Carbimazole

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7
Q

Two approaches in hyperthyroidism treatment with Carbimazole

A
  • titration- block: the dose is titrated to maintain normal levels (some production still occurs)
  • block and replace: the dose is sufficient to block all the production -> pt takes levothyroxine
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8
Q

2nd line drug for hyperthyroidism

*why is it not preferred?

A

Propylthiouracil

*used in a similar way to carbamazepine

* small risk of severe hepatic reaction (including death)

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9
Q

The principle behind radioactive iodine treatment of hyperthyroidism

A
  • single dose of radioactive iodine is drunk -> it is taken up by thyroid gland -> emitted radiation destroys a proportion of thyroid cells

Result: reduction in thyroid cells -> less thyroid hormone is produced

*it may take 6 months for the remission of hyperthyroid

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11
Q

What may happen to a patient who is treated with radioactive iodine for the hyperthyroidism?

A

Potentially patient may become hypothyroid - levothyroxine replacement needed

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12
Q

Strict (3) rules re hyperthyroidism treatment with radioactive iodine

A
  • Must not be pregnant and are not allowed to get pregnant within 6 months
  • Must avoid close contact with children and pregnant women for 3 weeks (depending on the dose)
  • Limit contact with anyone for several days after receiving the dose
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13
Q

which beta-blocker is used in hyperthyroidism or thyroid storm?

A

Propranolol is a good choice because it non-selectively blocks adrenergic activity as opposed to more “selective” beta blockers the work only on the heart.

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14
Q

What’s a definitive treatment for hyperthyroidism?

A
  • a definitive option is to surgically remove the whole thyroid or toxic nodules
  • the patient will be left hypothyroid post thyroidectomy and require levothyroxine replacement for life
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15
Q

The most common cause of hypothyroidism in developed world

A

Hashimoto Thyroiditis

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16
Q

Pathophysiology of Hashimoto’s thyroiditis

A

Autoimmune inflammation of thyroid gland

Antibodies:

  • antithyroid peroxidase (anti-TPO) antibodies
  • anti-thyroglobulin

Initially, a goitre is present -> then atrophy of thyroid gland develops

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17
Q

(2) antibodies associated with Hashimoto’s

A

Hashimoto’s = hypothyroidism

  • anti-peroxidase (anti-TPO)
  • antithyroglobulin
18
Q

What’s the most common cause of hypothyroidism in the developing world?

A

iodine deficiency

19
Q

What else, apart from Hashimoto’s and iodine deficiency can cause hypothyroidism

A

Hypothyroidism may develop secondary to treatment for hyperthyroidism (any treatment may have potential to do so)

20
Q

List treatments for hyperthyroidism (4)

A
  • Carbimazole
  • Prophylthiouracil
  • Radioactive iodine
  • Thyroid surgery
21
Q

What medications (2) may cause hypothyroidism?

A
  • Lithium - inhibits production of thyroid hormone
  • Amiodarone - interferes with thyroid hormone production and metabolism (causes hypo or hyperthyroidism)
22
Q

What’s secondary hypothyroidism

Possible causes

A

Hypothyroidism due to problems with pituitary gland (not enough TSH is produced)

Possible causes:

  • Tumours
  • Infection
  • Vascular (e.g. Sheehan Syndrome)
  • Radiation
23
Q

TSH and T3/T4 levels in primary hypothyroidism

A
24
Q

TSH and T3/T4 levels in secondary hypothyroidism

A
25
Q

Features in hypothyroidism

A
  • Weight gain
  • Fatigue
  • Dry skin
  • Coarse hair and hair loss
  • Fluid retention (oedema, pleural effusions, ascites)
  • Amenorrhoea
  • Constipation
28
Q

Management of hypothyroidism

A

Replacement of the hormone with Levothyroxine*

Levothyroxine is a synthetic T4 (it metabolise in the body to T3)

Endocrine (11 decks)

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