Thyroid Disorders

Question 1

which mechanism regulates amount of circulating thyroid hormone

Answer 1

neg feedback loop

Question 2

what does high levels of T3 + T4 supress?

Answer 2

suppresses the function/production of TSH or TRH = inhibit own production

TRH = thyrotropin-releasing hormone produced by hypothalamus

Question 3

levels of T3+T4 and TSH in hyperthyroidism

Answer 3

-high T3 + T4
-low TSH

Question 4

signs and symptoms of hyperthyroidism

Answer 4

-hyperactivity
-insomnia
-heat intolerance
-high appetite
-weight loss
-diarrhoea
-goitre (lump or swelling at the front of the neck caused by a swollen thyroid)

Question 5

hyperthyroidism and metabolism + activity

Answer 5

increased

Question 6

1st line tx of hyperthyroidism

Answer 6

carbimazole

Question 7

MHRA warnings of carbimazole

Answer 7

-neutropenia and agranulocytosis (REPORT sore throat, malaise, fever)
-congential malformations (contraception tx)
-acute pancreatitis (report and stop if signs develop)

Question 8

what should pt be cautious of in propythiouracil

Answer 8

liver disorder - jaundice, dark urine and nausea

Question 9

what can help with symptomatic relief with hyperthyroidism

Answer 9

beta blockers

Question 10

grave’s disease 1st line tx

Answer 10

radioactive iodine

Question 11

remission of grave’s disease tx

Answer 11

-if remission likely to be achieved with anti-thyroids use carbimazole

Question 12

if iodine and surgery not suitable + combo with?

2nd line of grave’s disease

Answer 12

carbimazole
-given as block and replace regimen in combo with levothyrox for 12-18MT

Question 13

Pregnancy and hyperthyroidism tx

Answer 13

-1st trimester = propythiouracil (carbimazole congenital defects)
-2-3rd trimester = carbimazole (propythiouracil hepatotoxicity)

Question 14

levels of T3+T4 and TSH in hypothyroidism

Answer 14

-low T3+T4
-high TSH

Question 15

signs and symptoms of hypothyroidism

Answer 15

-fatigue
-weight gain
-constipation
-depression
-dry skin
-intolerance to cold
-menstrual irregularities

Question 16

hypothyroidism and metabolism + activity

Answer 16

decreased

Question 17

first line tx of hypothyroidism

Answer 17

levothyroxine

Question 18

monitoring requirements and when to take levothyroxine

Answer 18

-monitor TSH every 3MT till stable then yearly
-take meds in morning at least 30 mins before breaky + caffeinated drinks

Question 19

brand specific

MHRA warning of levothyroxine

Answer 19

new guidance = small portion of pt can feel symptoms alternating between brands

Question 20

2nd line of hypothyroidism

Answer 20

liothronine

Question 21

liothronine output and brands

Answer 21

-more rapid and potent output than levothyroxine (20-25mcg = 100mcg of levo)
-non-UK brands may not be bioequivalent