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C HD ext. > Thyroid - Hyperthyroidism > Flashcards

Thyroid - Hyperthyroidism Flashcards

1
Q

What is primary thyroid disease?

A

Disease affecting the thyroid gland itself

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2
Q

Is primary thyroid disease always associated with a goitre?

A

No

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3
Q

Primary thyroid disease is most likely due to what type of disease?

A

Autoimmune

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4
Q

What will the TSH and free T3/4 levels be in primary hyperthyroidism?

A

TSH- low

Free T3/4- high

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5
Q

What causes secondary thyroid disease?

A

Hypothalamic or pituitary disease

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6
Q

What will the TSH and free T3/4 levels be in secondary hyperthyroidism?

A

TSH- high or ‘normal’

Free T3/4- high

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7
Q

Define thyrotoxicosis?

A

The clinical, physiological and biochemical state which arises when the tissues are exposed to too much thyroid hormone

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8
Q

Define hyperthyroidism?

A

Refers to the conditions in which overactivity of the thyroid gland leads to thyrotoxicosis

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9
Q

What are examples of thyrotoxicosis which ARE associated with hyperthyroidism?

A

Grave’s disease, toxic multi nodular goitre

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10
Q

What are examples of thyrotoxicosis which ARE NOT associated with hyperthyroidism?

A

Inflammation, thyroid treatment, ectopic production

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11
Q

What effect does hyperthyroidism have on thermogenesis?

A

Heat intolerance

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12
Q

What cardiac features can hyperthyroidism have?

A

Palpitations (AF), cardiac failure

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13
Q

Hyperthyroidism increases the activity of the sympathetic nervous system, what 2 clinical symptoms does this cause?

A

Increased sweating and tremor

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14
Q

What CNS effects does hyperthyroidism cause?

A

Anxiety, irritability, sleep disturbance

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15
Q

What GI effect does hyperthyroidism cause?

A

Diarrhoea

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16
Q

What are some vision problems that hyperthyroidism causes?

A

Lid retraction, double vision

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17
Q

What visual problem is specific to Grave’s disease?

A

Proptosis

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18
Q

What hair and nail changes does hyperthyroidism cause?

A
  • Thin, brittle hair

- Fast growing nails

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19
Q

What effect does hyperthyroidism have on the menstrual cycle and periods?

A

Change in pattern of menstrual cycle

Lighter and less frequent periods

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20
Q

What effect does hyperthyroidism have on the muscles? Where specifically?

A

Weakness- specifically in the thighs and upper arms

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21
Q

What effect does hyperthyroidism have on appetite and weight?

A

Increased appetite and weight loss

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22
Q

What type of disease is Grave’s?

A

Autoimmune

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23
Q

In Grave’s, there are polymorphisms in genes associated with what? What are some examples of these genes?

A

T cell function- CTLA-4 and PTPN- 22

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24
Q

85% of hyperthyroidism is due to what?

A

Grave’s disease

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25
Q

Which sex is affected more by Grave’s disease? How much more likely is this sex to suffer from the disease?

A

Women- 10 times more likely

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26
Q

What age group does Grave’s disease affect?

A

20-50

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27
Q

Sisters and children of women with Grave’s disease have what chance of getting a thyroid autoimmune condition?

A

5-8%

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28
Q

What social factor can make Grave’s disease more severe and harder to treat?

A

Smoking

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29
Q

What will thyroid function tests for Grave’s disease show?

A

Increased T3/4, decreased TSH

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30
Q

Grave’s disease is associated with what MSK condition?

A

Osteoporosis

31
Q

Increased bone turnover in osteoporosis does what to calcium and ALP levels

A

Raises them

32
Q

What is the major auto-antibody associated with Grave’s disease?

A

TRAb (TSH receptor antibody)

33
Q

What is diagnostic of Grave’s disease, without imaging?

A

Clinical signs and positive TRAb test

34
Q

What antibodies may be present in Grave’s disease besides TRAb?

A

Anti-TPO

Anti-thyroglobulin

35
Q

What are 4 clinical signs, specific to Grave’s disease?

A
  • Pretibial myxoedema
  • Finger clubbing
  • Thyroid bruit
  • Grave’s eye disease
36
Q

Grave’s eye disease affects around 20% of sufferers and has a strong association with what?

A

Smoking

37
Q

What is responsible for driving the pathology of Grave’s eye disease?

A

TRAb

38
Q

How is thyroid eye disease treated?

A

If mild- topically

If severe- steroids, radiotherapy, surgery

39
Q

What is the classic triad of Grave’s disease?

A

Hyperthyroidism with a goitre, eye changes and pretibial myxoedema

40
Q

In what two groups of people is toxic multi nodular goitre more common?

A

Elderly and iodine deficient

41
Q

What will thyroid function tests for toxic multi nodular goitre show?

A
  • TSH low

- Free T3/4 high

42
Q

Will there be autoantibodies in toxic multi nodular goitre?

A

No

43
Q

What investigations can be performed for toxic multi nodular goitre?

A
  • Iodine uptake scan

- US (+/- FNA)

44
Q

When does surgery become the first line treatment for a patient with toxic multi nodular goitre?

A

If the patient is showing compression symptoms e.g. dyspnoea or dysphagia

45
Q

What is the first line treatment for toxic multi nodular goitre?

A

Radioiodine

46
Q

What are examples of inflammatory causes of thyrotoxicosis?

A
  • Subacute DeQuervain’s
  • Post-partum
  • Drug induced (e.g. amiodarone)
47
Q

What are two examples of exogenous thyroid hormones causing thyrotoxicosis?

A
  • Overtreatment with thyroxine

- Thyrotoxicosis factitia

48
Q

What are two examples of ectopic thyroid production?

A

Metastatic thyroid carcinoma

Other carcinoid tumours

49
Q

What problem in the brain can cause thyrotoxicosis?

A

TSH secreting pituitary adenoma

50
Q

What is a thyroid storm?

A

Emergency severe hyperthyroidism

51
Q

What symptoms are present in a thyroid storm?

A

Respiratory and cardiac failure, hyperthermia and exaggerated reflexes

52
Q

Who is a thyroid storm typically seen in?

A

Hyperthyroid patients with an acute illness or following thyroid surgery

53
Q

How should you treat a thyroid storm?

A

Iodine, glucocorticoids, PTU, beta blockers, fluids and monitoring

54
Q

What is the mechanism of anti-thyroid drugs?

A

Inhibit TPO

55
Q

What is the first line drug for thyrotoxicosis? How often is it given?

A

Carbimazole once a day

56
Q

What is the risk of carbimazole during pregnancy?

A

Risk of aplasia cutis in early pregnancy

57
Q

What is the second line drug for thyrotoxicosis?

A

Propylthiouracil (PTU)

58
Q

When does PTU become the first line drug for thyrotoxicosis?

A

During the first trimester of pregnancy

59
Q

How often is PTU taken?

A

Twice daily

60
Q

How does PTU work?

A

Inhibits DI01 which decreased T4-T3 conversion

61
Q

There is a very low risk of what organ failure with PTU?

A

Liver

62
Q

What is the first line treatment for Grave’s Disease?

A

Drugs

63
Q

What are the two methods of giving drugs in Grave’s Disease?

A 
Dose titration (12-18 months)
Block and replace (6 months but higher recurrence)
64
Q

What is the treatment for recurrent Grave’s disease?

A

Radioiodine or surgery

65
Q

What are some generic complications of anti-thyroid drugs?

A
  • Allergic reactions
  • Cholestatic jaundice
  • Increased liver enzymes
  • Fulminant hepatic failure
66
Q

What is the major side effect of anti-thyroid drugs? What should patients be warned to look out for?

A

Agranulocytosis- stop the drug and get FBCs if there is fever, oral ulcers or oropharyngeal infections

67
Q

What specific drug is used for symptomatic relief during the first few weeks of treatment?

A

Propranolol

68
Q

Is there a risk of cancer with radio iodine?

A

No

69
Q

Is radio iodine safe in pregnancy?

A

No

70
Q

Aside from pregnancy, when else should radio iodine not really be used?

A
  • Thyroid eye disease (except with steroid cover)

- Those with young children (contact precautions)

71
Q

What downside can happen to patients following radio iodine treatment?

A

They become hypothyroid and have to take thyroxine

72
Q

When is a thyroidectomy used?

A

When radioiodine is contraindicated

73
Q

What are the risks of a thyroidectomy?

A

Recurrent laryngeal nerve palsy, hypothyroidism, hypoparathyroidism

C HD ext. (5 decks)

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