Thyroid Disorders

Question 1

How does thyroid hormones work

Answer 1

The amount of circulating thyroid hormones is regulated by a negative feedback loop

High levels of T3 and T4

Suppresses the function/production of TSH or TRH (thyrotropin releasing hormone produced by the hypothalamus) = inhibit their own production

Question 2

What is meant by hyperthyroidism

Answer 2

High T3 and T4 and LOW TSH

Question 3

What are the signs and symptoms of hyperthyroidism

Answer 3

Hyperactivity
Insomnia
Heat intolerance
Increased appetite
Weight loss
Diarrhoea
Goitre

There is an increased metabolism and activity

Question 4

What is the treatment of hyperthyroidism

Answer 4

First line: Carbimazole

Second line: propylthiouracil
-patients should be cautious of liver disorders = jaundice, dark urine and nausea

Beta blockers can be used to help with symptomatic relief

Question 5

What are the MRHA warnings about carbimazole

Answer 5

Neutropenia and agranulocytosis= report sore throats, malaise and fever

Congenital malformation = women use contraception during treatment

Acute pancreatitis- report and stop immediately if develops signs

Question 6

What is the treatment of Graves’ disease

Answer 6

First line: Radioactive iodine
- if remission likely to be achieved with anti-thyroid, can consider carbimazole
- use carbimazole if iodine or surgery is not suitable
— given as a block and replacement regimen in combination with levothyroxine for 12-18 months

Question 7

What is the first line treatment for hyperthyroidism in pregnancy

Answer 7

1st trimester- propylthiouracil (due to carbimazole congenital defects)
2nd and 3rd trimester: carbimazole (due to propylthiouracils hepatotoxicity)

Question 8

What is meant by hypothyroidism

Answer 8

Low T3 and T4 levels and high TSH

Question 9

What are the signs and symptoms of hypothyroidism

Answer 9

Fatigue
Weight gain
Constipation
Depression
Dry skin
Intolerance to the cold
Menstrual irregularities

There a decrease metabolism and activity

Question 10

What is the treatment of hypothyroidism

Answer 10

First line : levothyroxine
Monitor the TSH: every 3 months until stable then yearly thereafter
Take the medicine in the morning, at least 30 mins before having breakfast or caffeinated drinks

Question 11

What is the MRHA warning about levothyroxine

Answer 11

New guidance that a small portion of patients can feel symptoms if alternating between brands

Question 12

What is liothyronine

Answer 12

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