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Gen Surg (Breast and Thyroid) > Thyroid - Thyrotoxicosis > Flashcards

Thyroid - Thyrotoxicosis Flashcards

1
Q

What effect does thyrotoxicosis have on weight and appetite?

A

Increased appetite and weight loss

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2
Q

What arrhythmias may be seen in patients with thyrotoxicosis?

A

Atrial fibrillation, SVT

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3
Q

Are individuals with thyrotoxicosis intolerant of the heat or the cold?

A

Heat

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4
Q

What effect does thyrotoxicosis have on the menstrual cycle?

A

Lighter and less frequent periods +/- infertility

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5
Q

How does a thyroid storm typically present?

A

Respiratory and cardiovascular collapse, hyperthermia and brisk reflexes

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6
Q

When does a thyroid storm typically occur?

A

In those with pre-existing thyrotoxicosis with acute illness or after thyroid surgery/radioiodine treatment

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7
Q

A thyroid storm should be treated with an ABCDE approach. What medication is given to counteract the peripheral effects of thyroid hormones?

A

Beta blockers (propranolol)

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8
Q

Which autoantibodies are most commonly associated with Grave’s disease?

A

Anti TSH receptor antibodies (TRAb)

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9
Q

What are some potential triggers for Grave’s disease?

A

Stress, infection, childbirth

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10
Q

Who does Grave’s disease typically affect?

A

Women aged 20-50

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11
Q

What are some signs of thyrotoxicosis that are specific to Grave’s disease?

A

Pretibial myxoedema, Grave’s eye disease, thyroid bruit, thyroid acropatchy

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12
Q

What is the biggest risk factor for Grave’s eye disease?

A

Smoking

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13
Q

What is the relationship between Grave’s eye disease and gender?

A

It is less likely to occur in males, but when it does it is usually worse

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14
Q

Low TSH, high free T3/4 and high TRAb levels suggests what diagnosis? Are any further investigations necessary?

A

Grave’s disease - no further investigations are necessary

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15
Q

Hypercalcaemia and a high ALP in those with Grave’s disease suggests that what complication has occurred?

A

Osteoporosis

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16
Q

Who is toxic multinodular goitre most commonly seen in?

A

The elderly, and those from iodine deficient areas

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17
Q

Low TSH, high free T3/4, antibody and inflammatory markers negative suggests what diagnosis? Are any further investigations necessary?

A

Toxic multinodular goitre - a radioisotope scan, ultrasound +/- FNA will also be required to confirm the diagnosis

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18
Q

Will a radioisotope scan of toxic multinodular goitre be hot, warm or cold?

A

Hot

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19
Q

If a person has thyrotoxicosis and undergoes a radioisotope scan which shows a hot solitary nodule, but the rest of the gland is suppressed, what diagnosis does this suggest?

A

Toxic solitary adenoma

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20
Q

What are some inflammatory causes of thyrotoxicosis?

A

DeQuervain’s thyroiditis, postpartum thyroiditis, drug induced thyroiditis

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21
Q

What drug is most likely to cause thyrotoxicosis?

A

Amiodarone

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22
Q

If someone presents with thyrotoxicosis, and has a raised T4, low T3 and low thyroglobulin, what diagnosis does this suggest?

A

Over-treatment with levothyroxine (accidental or factitious)

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23
Q

What are some potential causes of ectopic endogenous thyroid hormone exposure leading to thyrotoxicosis?

A

Metastatic follicular thyroid carcinoma, ovarian teratoma, carcinoid tumours

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24
Q

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

A

Medical management

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25
Q

What is the mechanism of action of both drugs that can be used to treat Grave’s disease?

A

Inhibition of TPO (thereby blocking thyroid hormone synthesis)

26
Q

What is the first line drug used to treat Grave’s disease?

A

Carbimazole

27
Q

What is the second line drug used to treat Grave’s disease?

A

Propothiouracil (PTU)

28
Q

When should PTU be used over carbimazole in the treatment of Grave’s disease?

A

In early pregnancy

29
Q

What is the major side effect of carbimazole to be aware of and patients should be warned of?

A

Agranulocytosis

30
Q

Drugs used to treat Grave’s disease are most likely to cause side effects related to which body organ?

A

Liver (jaundice, raised enzymes, hepatic failure)

31
Q

The risk of agranulocytosis with carbimazole treatment is highest when?

A

In the first 6 weeks of treatment

32
Q

If patients taking carbimazole experience any symptoms/signs of infection, what blood test must be taken urgently?

A

FBC

33
Q

What medication can be useful for symptomatic relief from thyrotoxicosis?

A

Beta blockers (propranolol)

34
Q

Explain what is meant by the titration method of giving carbimazole to patients with Grave’s disease?

A

Carbimazole is given for 4 weeks and the dose is reduced gradually every 1-2 months according to the TFTs

35
Q

Explain what is meant by the block and replace method of giving carbimazole to patients with Grave’s disease? What is the main advantage of this method?

A

Carbimazole and levothyroxine are given simultaneously - this reduces the risk of iatrogenic hypothyroidism

36
Q

How long should patients with Grave’s disease be maintained on medications? What is the outcome after this?

A

12-18 months - after this 50% will be treated and 50% will relapse, requiring radioiodine or surgical treatment

37
Q

What is the first line treatment for toxic multinodular goitre?

A

Radioiodine

38
Q

What is the second line treatment for Grave’s disease if medical management fails?

A

Radioiodine

39
Q

What isotope is most commonly used to treat thyrotoxicosis?

A

131 iodine

40
Q

What are the outcomes of a single oral dose of 131 iodine when treating thyrotoxic patients?

A

50% hypothyroid, 20% hyperthyroid, 30% euthyroid

41
Q

Does radioiodine treatment for thyrotoxicosis increase the risk of developing thyroid cancer?

A

No

42
Q

What are the contraindications to radioiodine treatment for thyrotoxicosis?

A

Pregnancy, breastfeeding, children, Grave’s eye disease (relative)

43
Q

It is advised to avoid pregnancy for how long after receiving radioiodine treatment for thyrotoxicosis?

A

4 months

44
Q

What is the first line management option for toxic multinodular goitre causing compression symptoms e.g. dysphagia, dyspnoea?

A

Surgical management

45
Q

What is the next best management option for toxic multinodular goitre or Grave’s disease when radioiodine treatment is contraindicated?

A

Surgical management

46
Q

What is the surgical procedure of choice for treating thyrotoxicosis?

A

Subtotal thyroidectomy

47
Q

What must patient’s thyroid function be before undergoing surgery for thyrotoxicosis and why?

A

Normal - to reduce the risk of complications, especially a thyroid storm

48
Q

What are some risks of subtotal thyroidectomy for thyrotoxicosis?

A

Hypothyroidism, hypoparathyroidism, recurrent laryngeal nerve palsy

49
Q

If an individual has thyrotoxicosis, and they have patchy uptake on radioisotope scanning, what is the most likely diagnosis?

A

Toxic multinodular goitre

50
Q

If an individual has thyrotoxicosis, and they have uniform uptake but diffuse enlargement of both lobes of the thyroid, what is the most likely diagnosis?

A

Grave’s disease

51
Q

How should a thyroid storm be treated?

A

Beta blockers, PTU, hydrocortisone

52
Q

What effect can thyrotoxicosis have on the heart, particularly of elderly individuals?

A

High output cardiac failure

53
Q

What happens to the level of thyroxine binding globulin and T4 output in pregnancy?

A

Increased

54
Q

What happens to levels of TSH in the first trimester of pregnancy and why?

A

They decrease, because it is suppressed by HCG

55
Q

What happens to the severity of pre-existing thyrotoxicosis in and around pregnancy?

A

Generally improves in pregnancy, but may experience transient exacerbations in the first trimester and post-partum

56
Q

Why is PTU used over carbimazole for thyrotoxicosis which is diagnosed during pregnancy?

A

Less crosses the placenta and less is concentrated in breast milk

57
Q

Can thyroid surgery be performed in pregnancy?

A

Only in the second trimester

58
Q

If a pregnant mother has been on anti-thyroid medications, signs of neonatal thyrotoxicosis may not occur until when?

A

7-10 days post-partum

59
Q

What is the outcome of neonatal thyrotoxicosis?

A

Most cases resolve spontaneously by 2-3 months

60
Q

What are some long-term effects of neonatal thyrotoxicosis that may occur?

A

Motor difficulties and hyperactivity

Gen Surg (Breast and Thyroid) (8 decks)

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