Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endocrinology > Thyrotoxicosis and hyperthyroidism > Flashcards

Thyrotoxicosis and hyperthyroidism Flashcards

1
Q

Are all cases of thyrotoxicosis associated with hyperthyroidism?

A

No, thyrotoxicosis is the result of increased thyroid hormone, but this excess thyroid hormone doesn’t always come from an overactive thyroid gland (Hyperthyroidism)

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

How can hyperthyroidism cause thyrotoxicosis?

A
  • Excessive thyroid stimulation
  • Autonomous thyroid nodules
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some thyroid nodules that can become autonomous?

A

Toxic solitary nodule
Toxic multi-nodular goitre

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

What are some causes of excessive thyroid stimulation?

A

Grave’s disease
Hashitoxicosis
Thyrotropinoma (TSHoma)
Thyroid cancer
Choriocarcinoma

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

What are some non-hyperthyroid associated causes of thyrotoxicosis?

A

Thyroiditis
Exogenous thyroid hormones
Ectopic thyroid tissue

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

What are some causes of exogenous thyroid hormones in thyrotoxicosis?

A

Over-treatment with levothyroxine
Thyrotoxicosis factitia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some examples of ectopic thyroid tissue?

A

Metastatic thyroid carcinoma
Struma ovarii (Teratoma containing thyroid tissue)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is Grave’s disease?

A

Grave’s disease is a type IIb autoimmune condition in which auto-antibodies bind to and activate TSH receptors, increasing T3 and T4 secretion

This causes hyperthyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the most common cause of hyperthyroidism in younger patients (20-50)?

A

Grave’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the goitre formed in Grave’s disease

A

Smooth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the main symptoms in Grave’s disease?

A
  • Hyperthyroidism with diffuse enlargement of the thyroid (Smooth goitre)
  • Grave’s eye disease (Exophthalmos)
  • Pre-tibial myxoedema
  • Thyroid acropachy (Finger clubbing)
  • Thyroid bruit (Associated with large goitres, reflective of hypervascularity of the thyroid)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What symptom of Grave’s disease is shown here?

A

Pre-tibial myxoedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is Grave’s eye disease?

A

A TRAb driven condition occurring in 20% of Grave’s patients, in which there is bulging of the eyes and lid retraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some other names of Grave’s eye disease?

A

Thyroid eye disease (TED)
Grave’s opthalmopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What will blood testing show in Grave’s disease?

A
  • Low TSH
  • Raised fT4/3
  • Hypercalcaemia and raised ALP (increased bone turnover)
  • Leucopenia
  • TSH receptor antibody (TRAb)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the most common antibody found in Grave’s disease?

A

TSH receptor antibody (TRAb) (70-100%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the least common antibody found in Grave’s disease?

A

Anti-thyroglobulin (30-50%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How will Grave’s disease be managed?

A

Mild disease is treated topically e.g. lubricants

Severe disease is treated with steroids, radiotherapy (Poor evidence) and surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the most common cause of primary hyperthyroidism in older patients (>50)?

A

Nodulatr thyroid disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How will nodular thyroid disease present?

A

Insidious onset formation of asymmetrical goitre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What will testing show in nodular thyroid disease?

A
  • Raised fT3/4
  • Low TSH
  • TRAb negative
  • Scintigraphy shows high uptake (Iodine uptake scanning)
  • Thyroid ultrasound
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the main symptoms of thyrotoxicosis?

A
  • Increased BMR
  • Very fast pulse rate
  • Increased nervousness and excessively emotional
  • insomnia
  • Sweating & heat intolerance
  • Tendency to lose weight easily
  • Tremors
  • Muscle weakness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are some cardiac symptoms of thyrotoxicosis?

A

Palpitations
Atrial fibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are some neurological symptoms of thyrotoxicosis?

A

Anxiety
Nervousness
Irritability
Sleep disturbance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are some gastrointestinal symptoms of thyrotoxicosis?

A

Frequent, loose bowel movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are some visual symptoms of thyrotoxicosis?

A
  • Lid retraction
  • Double vision (Diplopia)
  • Proptosis (Grave’s disease)
26
Q

What are some hair and skin symptoms of thyrotoxicosis?

A
  • Brittle, thin hair
  • Rapid fingernail growth
27
Q

What are some menstrual cycle changes that occur in thyrotoxicosis?

A

Lighter bleeding
Less frequent periods

28
Q

What is a thyroid storm?

A

A medical emergency in which there is severe hyperthyroidism

29
Q

What are some symptoms of thyroid storms?

A
  • Respiratory or cardiac collapse
  • Hyperthermia
  • Exaggerated reflexes
30
Q

Who is most at risk of thyroid storm?

A

Hyperthyroid patients, with an acute infection or recent thyroid surgery

31
Q

How is thyroid storm managed?

A
  • Lugol’s iodine
  • Glucocorticoids
  • PTU
  • ß-blockers
  • Fluids
  • Monitoring
  • Mechanical ventilation (If respiratory collapse)
32
Q

What will blood detesting show in primary hyperthyroidism?

A

High fT3/4
Low TSH

33
Q

What will blood testing show in secondary hypothyroidism?

A

High fT3/4
High TSH

34
Q

How do anti-thyroid drugs?

A

They inhibit TPO, therefore blocking thyroid hormone synthesis

35
Q

What are some examples of anti-thyroid drugs?

A
  • Carbimazole
  • Propylthiouracil (PTU)
36
Q

What is the first line antithyroid drug in hyperthyroidism?

A

Carbimazole

37
Q

How often is carbimazole taken?

A

Once daily

38
Q

What can occur is carbimazole is taken during early pregnancy?

A

Aplasia cutis (Missing patches of skin on the babies scalp)
GI abnormalities
Choanal and oesophageal atresia

39
Q

When is PTU used 1st line in hyperthyroidism?

A

In early pregnancy

40
Q

How often is PTU taken?

A

Twice daily

41
Q

What disease are PTU patients more at risk of?

A

Liver failure (1 in 10,000)

42
Q

What are some possible side effects of anti-thyroid drugs?

A
  • Rash, urticaria, arthralgia
  • Cholestatic jaundice, raised liver enzymes
  • Agranulocytosis
43
Q

What is agranulocytosis?

A

Agranulocytosis is a lack of granulocytes in the blood, meaning the patient is at a high risk of infection

44
Q

Can anti-thyroid drugs be used again after agranulocytosis occurs?

A

NO!

45
Q

What is done to screen patients on anti-thyroid drugs for agranulocytosis?

A

Patients should be warned verbally, and in writing to stop the drug or to have urgent FBC checking in event of fever, ulcer or oropharyngeal infection

46
Q

What are some management options of hyperthyroidism?

A

Anti-thyroid drugs
ß-Blockers
Radioiodine
Thyroidectomy

47
Q

What is the use of ß-blockers in hyperthyroidism?

A

For immediate symptomatic relief of thyrotoxic symptoms due to its activity in reducing activity of the sympathetic nervous system

48
Q

What is the main ß-blocker use din hyperthyroidism?

A

Propanolol

49
Q

When is radio iodine used in hyperthyroidism?

A

relapsed Grave’s disease and nodular thyroid disease

50
Q

When is radio iodine contraindicated?

A

It is contraindicated in pregnancy and is relatively contraindicated in active thyroid eye disease (Can be used with a steroid cover)

51
Q

What is a possible complication of radio iodine usage in Grave’s disease?

A

High risk of hypothyroidism when used in Grave’s disease

52
Q

When is thyroidectomy indicated in hyperthyroidism?

A

When radio iodine is contraindicated

53
Q

What are some possible risks of thyroidectomy in hypertension?

A

Recurrent laryngeal nerve palsy
Hypothyroidism
Hyperparathyroidism

54
Q

How does hCG affect the thyroid?

A

hCG causes stimulation of thyroxine release, which causes suppression of TSH

55
Q

What are some symptoms of high hCG levels that help to distinguish it from hyperthyroidism?

A
  • Hyperemesis gravidarum
  • Not TRab antibody positive
  • TSH low and not fully suppressed
  • Resolves by 20 weeks gestation
56
Q

When is gestational hCG-asscoiated thyrotoxicosis treated?

A

If it lasts longer than 20 weeks gestation

57
Q

What can hyperthyroidism in pregnancy increase the risk of?

A
  • Infertility
  • Ammenorhoea
  • Spontaneous miscarriage
  • Stillbirth
  • Thyroid crisis in labour
  • Transient neonatal thyrotoxicosi
58
Q

What are some possible causes of hyperthyroidism in pregnancy?

A
  • Grave’s disease
  • Toxic multinodular goitre
  • Toxic adenoma
  • Thyroiditis
59
Q

How is hyperthyroidism usually managed in pregnancy?

A

Wait-and-see approach with supportive management given if necessary (ß-blockers)

60
Q

If required, which low-dose antithyroid drugs given in pregnancy?

A
  • Propylthiouracil 1st trimester
  • Carbimazole 2/3rd trimester
61
Q

What are soem possible side effects of propylthiouracil (PTU) in pregnancy?

A

Embryopathy
Liver toxicity

62
Q
A

Endocrinology (42 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions