Thyrotoxicosis Flashcards

1
Q

What are the symptoms of thyrotoxicosis?

A
  • Diarrhoea; weight; appetite (if , paradoxical weight gain in 10%); over-active; sweats; heat intolerance; palpitations; tremor; irritability; labile emotions; oligo menorrhoea ±infertility. Rarely psychosis; chorea; panic; itch; alopecia; urticaria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the signs of thyrotoxicosis?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the signs of Graves’ disease?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What investigations are carried out to test for thyrotoxicosis?

A
  • Low TSH, High T4 and T3
  • Mild normocyctic anaemia
  • Mild neutropenia (in Graves)
  • Increased ESR, Calcium and LFTs
  • Check for the presence of thyroid autoantibodies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the causes of thyrotoxicosis?

A
  • Graves disease
  • Toxic multinodular goitre
  • Toxic adenoma
  • Ectopic thyroid tissue
  • Exogenous - iodine excess, levothyroxine excess
  • Other
    • Subacute de Quervain’s thyroiditis which is a self-limiting post viral with painful goitre
      • Treat with NSAIDs
    • Drugs
      • Amiodarone
      • Lithium
    • Post-partum
    • TB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the causes of Graves’ disease?

A
  • Circulating IgG autoantibodies binding to and activating G- protein coupled thyrotropin receptors which cause smooth thyroid enlargement and increased hormone production
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the triggers of Graves’ disease?

A
  • Stress
  • Infection
  • Childbirth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do patients with Graves’ disease present?

A
  • Hyperthyroid
  • May become hypothyroid or euthyroid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is Graves’ disease associated with?

A
  • Other autoimmune diseases:
    • Vitiligo
    • T1DM Addisions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is thyrotoxicosis treated?

A
  • Drugs
    • Propranolol for symptom control
    • Anti-thyroid medication
      • Carbimazole
      • Carbimazole and Levothyroxine
  • Radioiodine
  • Thyroidectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the side effects of carbimazole?

A
  • Agranulocytosis
  • Decreased neutrophils
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the contraindications of radioiodine?

A
  • Pregnancy
  • Lactation
  • Most patients become hypothyroid post treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the risks of thyroidectomy?

A
  • Risk of damage to recurrent laryngeal nerve (hoarse voice)
  • Hypoparathyroidism
  • Patients will become hypothyroid so thyroid replacement is needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is thyroid eye disease?

A
  • Thyroid eye disease (TED) is an eye condition in which the eye muscles and fatty tissue behind the eye become inflamed.
  • This can cause the eyes to be pushed forward (‘staring’ or ‘bulging’ eyes) and the eyes and eyelids to become swollen and red.
  • Rarely TED can cause blindness from pressure on the nerve at the back of the eye or ulcers forming on the front of the eyes.
  • TED is an autoimmune disease. It occurs when the body’s immune system attacks the back of the eye and causes inflammation.
  • It is mainly associated with an over-active thyroid due to Graves’ disease, although it does sometimes occur in people with an under-active or normally functioning thyroid.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the main risk factor of thyroid eye disease?

A

Smoking

17
Q

What are the complications of thyrotoxicosis?

A
  • Heart failure (thyrotoxic cardiomyopathy, increased in elderly)
  • Angina
  • AF
  • Osteoporosis
  • Opthalmopathy
  • Gynaecomastia
  • Thyroid storm
18
Q

What are the symptoms of thyroid eye disease?

A
  • Eye discomfort
  • Grittiness
  • Increased tear production
  • Photophobia
  • Diplopia
  • Decreased visual acuity
19
Q

What are the signs of thyroid eye disease?

A
  • Exopthalmus
  • Conjuctival oedema
  • Corneal ulceration
  • Papilloedema
  • Loss of colour vision
  • Opthalmoplegia (especially on upward gaze)
    • Occurs due to muscle swelling and fibrosis
20
Q

How is thyroid eye disease diagnosed?

A
  • Clinical diagnosis
  • CT/MRI of orbits may reveal enlarged eye muscles
21
Q

How is thyroid eye disease managed?

A
  • Get specialist help
  • Treat hyper or hypo-thyroidism
  • Smoking cessation
  • Treat symptoms
  • Surgical decompression
  • Future options:
    • Anti-TNF alpha antibodies
22
Q

What are the causes of goitre?

A
  • Diffuse:
    • Physiological
    • Graves disease
    • Hashimoto’s thyroiditis
    • Subacute de Quervain’s thyroiditis (painful)
  • Nodular
    • Multinodular goitre
    • Adenoma
    • Carcinoma
23
Q

What can make thyroid eye disease worse?

A

Radioiodine treatment