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MD4001 Week 9 > Treatment of Thyroid Disorders > Flashcards

Treatment of Thyroid Disorders Flashcards

1
Q

Symptoms of hyperthyroidism?

A

High BMR

Anxiety

insomnia

Eyelid retraction

Hand tremors

Excessive sweats

Goitre

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2
Q

What are two common manifestation of hyperthyroidism?

A

Diffuse toxic goitre- autoimmune disorder where antibodies to the TSH receptor stimulate thyroxine secretion

Toxic nodular goitre- benign neoplasm/ adenoma

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3
Q

What are the causes of hyperthyroidism?

A

Graves disease

Overtreatment with thyroxine

Thyroid adenoma

Transient neonatal thyrotoxicosis (mother with Graves disease)

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4
Q

What investigations can you do to test for thyroid disorders?

A

Measure blood TSH, free T3 and T4 levels

Test for anti-thyroid antibodies

Radionucleotide thyroid scan

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5
Q

How does graves disease appear on radionucleotide scan?

A

Enlarged darker area of thyroid

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6
Q

How does subacute thyroiditis appear on scan?

A

Does not appear

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7
Q

How does follicular adenoma appear on scan?

A

Circular dark spot

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8
Q

What is the the treatment of hyperthyroidism?

A

Radioactive iodine

Anti-thyroid drugs

Surgery

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9
Q

What are the con and pros of hyperthyroidism?

A

None is optimal

None interrupts the autoimmune process

Each has a drawback

No other research options so far

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10
Q

Describe the use of radioactive iodine?

A

Radioiodine is given orally

Given as a single dose and lasts about 2 months

It damages cells by emitting short range beta radiation and affects only the follicle cells

Hypothyroidism will eventually occur which can be treated with replacement therapy

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11
Q

What drugs are used to treat hyperthyroidism?

A

Thioureylenes

Carbimazole (methimazole)

Propylthiouracil

Iodine

Beta blockers

Calcium supplements

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12
Q

Mechanism of Thioureylenes, Carbimazole (methimazole), Propylthiouracil

A

Decrease the synthesis of thyroid hormones

Inhibit thyroid peroxidase so reducing the iodination of thyroglobulin

Acts over 3-4 weeks.

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13
Q

Mechanism of iodine?

A

Given orally in high doses and is converted to iodide and transiently reduced thyroid hormone secretion and vascularity of the gland

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14
Q

Why would you give calcium supplements?

A

Maintenance of normal bone density

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15
Q

What thioamides are given?

A

Carbimazole

Methimazole

Both inhibit thyroid peroxidase

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16
Q

Symptoms of hypothyroidism?

A

Low metabolic rate

Slow speech

Deep hoarse voice

Lethargy

Bradycardia

Sensitivity to cold

Mental impairment

Thickening of skin

Cretinism in children

17
Q

What does myxedema refer to?

A

Dermatological changes associated with both hyperthyroid and hypothyroid conditions

Accumulation of increased amounts of hyaluronic acid and chondroitin sulfate in the dermis in both lesioned and normal skin causing swelling/puffiness of the subcutaneous skin tissue

18
Q

What level are low in hypothyroidism?

A

Low T4

Possible low T3

Raised TSH (unless pituitary problem!)

Possibly various anti-thyroid antibodies

19
Q

What are the congenital causes of hypothyroidism?

A

Hypoplasia

Familial enzyme defects

Iodine deficiency

Intake of goitrogens during pregnancy

Pituitary defects

Idiopathic

20
Q

What are the acquired causes of hypothyroidism?

A

Iodine deficiency

Auto-immune thyroiditis

Thyroidectomy or RAI therapy

TSH or TRH deficiency

Medications

Idiopathic

21
Q

Describe Hashimoto’s disease?

A

Most common cause of hypothyroidism

Autoimmune lymphocytic thyroiditis

Anti-thyroid antibodies

Females>males

Runs in families

22
Q

What are the anti-thyroid antibodies?

A

Thyroglobulin

Microsomal Ab/Thyroid peroxidase

TSH-R Ab

23
Q

Drugs used in hypothyroidism?

A

Levothyroxine

Liothyronine

24
Q

Describe levothyroxine?

A

Synthetic analogue of thyroxine

Has all actions of endogenous thyroxine

Standard T4 replacement therapy for hypothyroidism

25
Q

Describe liothyronine?

A

Synthetic analogue of triiodothyronine

Has all the actions of endogenous tri-iodothyronine

Treatment of choice for myxedema coma

26
Q

Symptoms of myxedema coma?

A

Stressful state such as an infection, MI or stroke caused by hypothyroidism

MD4001 Week 9 (8 decks)

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