thyroid disease

Question 1

primary hypothyroidism is more common in men or women

Answer 1

women

same with hypothyroidism

Question 2

how do thyroid hormones affect carbohydrate synthesis

Answer 2

they increase the metabolism of carbohydrates, fats, proteins with direct control over the enzymes affecting carb metabolism and synergistic effect with other hormones such as insulin, glycogen and cortisol and catecholamines

Question 3

primary hypothroidism

Answer 3

affect the thyroid gland itself. autoimmune, surgery, radioactive iodine.
inherited disorders
iodine deficiency
drug induced - lithium, amiodorone, anti-thyroid medicines

Question 4

secondary hypothyroidism

Answer 4

results rom factors interfering with the secretion of TSH from the pituitary gland

Question 5

tertiary hypothyroidism

Answer 5

occurs when there is an issue with secretion of TRH from the hypothalamus

collectively secondary and tertiary hypothyroidism are referred to as central hypothyroidism and can be caused by damage to the pituitary or hypothalamus by tumour, infiltration or trauma

Question 6

hypothyroidism symptoms

Answer 6

fatigue, weakness

• intolerance to cold conditions
• depression
• • weight gain
• joint aches
• dry skin/ hair loss
• constipation
• menstrual irregularities

Question 7

Levels for hypo

Answer 7

TSH high L3 and 4 normal - early onset and no symptoms

TSH high and T3 and 4 low = symptomatic

TSH low, T4 low and T3 high - central hypothyroidism

Question 8

hypothyroidism is often associated with

Answer 8

anaemia, hyponatraemia, hypercholesterolaemia and elevated creatine kinase

Question 9

levothyroxine

Answer 9

T4

start 50-100 and increase every 3-4 weeks by 25-50mcg

Question 10

in elderly or patients with cardiac disorders what dose do we start at

Answer 10

25mcg and steps of 25mcg every 4 weeks

Question 11

central hypothyroidism

Answer 11

trough T3 and 4 levels guide dose

we want middle range

Question 12

myxoedema coma

Answer 12

identify and treat the precipitating factor e.g. electrolyte abnormalities or infection

hypothyroid coma

liothyronine 5-20mcg IV BD

Question 13

causes of hypothyroidism / thyrotoxicosis

Answer 13

autoimmune antibody mediated (Graves disease) - these patients also have a diffuse goitre and opthlamopathy. Thyroid eye disease.

inflammation of thyroid gland - thyroiditis (viral or immune attack) - treat with red

nodular disease (toxic multi nodular goitre)

Question 14

signs of hyperthyroidism

Answer 14

• palpitations
• nervousness/shaking/insomnia
• difficulty concentraing/irritability
• emotional lability
• increased appetite
• heat intolerance
• fatigue/weakness/exertional dynode
• hyperdefication
• brittle hair
• increases menses

Question 15

hyperthyroidism test

Answer 15

low TSH
high T3 and T4

also may be companies with mild leukopenia, anaemia, transaminitis, raised ALP (from the bone) mild hypercalcaemia, low albumin and low cholesterol.

Question 16

pharmacological treatments for hyperthyroidism

Answer 16

carbimazole (15mg-40mg daily until patient becomes euthyroid usually takes 4-8 weeks, the dose can then be reduced)

propylthiouracil (200-600mg daily and then reduced to 50-150mg daily)

cartbimazole 1mg = propylthiouracil 10mg.

patients usually on treatment for 6 m- 2 years and then when stopped can remain euthyroid for 10 years

iodine 0.1ml-0.3ml TDS

Question 17

block and replace regime

Answer 17

carbimazole 40-60mg (highe) then small dose of levy 50-100

Question 18

carbimazole is associated with

Answer 18

neutropenia and agranulocytosis

infection, bruising, sore throat

Question 19

propylthiouracil is associated with

Answer 19

hepatic reactions

Question 20

does caffeine increase or reduce the absorption of levothyroxine?

Answer 20

Reduce

Question 21

are patients with hyperthyroidism exempt from prescription charges?

Answer 21

No

it is hyperparathyroidism