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Endo yr 2 > HYPERTHYROIDISM > Flashcards

HYPERTHYROIDISM Flashcards

1
Q

where is thyroxine stored

A

in thyroglobulin in thyroid follicular cells

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2
Q

what is the full name of T4

A

THYROXINE

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3
Q

FULL NAME of t3

A

triiodothyronine

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4
Q

how much thyroxine is approx stored in your thyroid any given moment (how long would you last with it)

A

1 month worth

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5
Q

how does the pituitary help thyroxine formation

A

1) increases iodine uptake and oxidises it to inorganic
2) stimulates tsh

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6
Q

what does TSH do exactly

A

goes down to thyroid follicular cells activates enzymes that trigger the release of stored thyroxine (t4) into blood

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7
Q

where does t4 provide negative feedback?

A

pituitry AND hypothalamus

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8
Q

thyroid related hormone released by hypothalamus and on what cells does it act

A

thyrotropin releasing hormone on thyrotrophs in anterior pit

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9
Q

what happens to TSH levels when autoimmune hypothyroidism?

A

tsh goes up

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10
Q

is graves disease autoimmune
hyper or hypothyroididsm

A

hyper

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11
Q

mechanism of graves

A

TSH- receptor antibodies (TRAb) bind to and stimulate TSH receptor in thyroid

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12
Q

symptoms of graves (ones i remember easily)

A

everything hyeprworking so:

visual:
- lid lag
-exophtalmos- cubbed fingers in severe exophtalmos cases

tempeprature and gastro:
- hot, flushing, hungry, eating more but losing weight, diarrhea

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13
Q

other graves symptoms (ACRONYM: HERE) (harder)

A

HEART+ respiration: rapid pulse, palpitation, tachycarida, breathless

EMOTIONAL: nervousness excitsbiluty, restlessness, emotional instability, insomnia

REPROD: oligomenorrhea or amenorrhea

EXTERNAL: observable in appearance: localized myxedema, tremor, muscular weakness

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14
Q

Mechanism of exophtalmos

A

antibodies bind to muscle behind the eyes

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15
Q

what is pretibial myxoedema

A

non pitting oedema (you cant squish it in) in the shins in graves disease

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16
Q

what does myxoedema refer to?

A

hypothyroidism

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17
Q

what is the first line investigation to confirm graves disease

A

measuring TRABin blood

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18
Q

what happens to the thyroid in graves disease

A

diffuse (omiomorfo) enlargement ( smooth goitre) and engorgement (bleeds very easily)

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19
Q

how does graves disease thyroid look in radiology scan after giving radioiodine?

A

whole thing “lights up” in black

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20
Q

does toxic nodular disease lead to hyper or hypothyroidism

A

hyperthyroidism

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21
Q

2 categories of toxic nodular disease

A

single toxic nodul or multiple toxic nodules (multinodular goitre)

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22
Q

what is the mechanism behind toxic nodular disease

A

benign adenomas that are overactive at making thyroxine

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23
Q

how does toxic nodule disease look in radiology scan after giving radioiodine?

A

only hot nodule lights up in black

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24
Q

by what mechanism does thyroxine act on the sympathetic nervous system?

A

sensitizes beta adrneoreceptors to ambient (surrounding) adrenaline and noradrenaline so activates symp nervous system

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25
Q

what are the symptoms caused by the activation of the symp nervys system by thyroxine?

A

tachycardia, palpitations, tremor in hands, lid lag

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26
Q

what is a thyroid storm, how do you react if you catch it?

A

when you are so hyperthyroid that it turns into a medical emergency, 50% mortality if untreated, treat it QUICKLY

27
Q

what are the alarm symptoms of htyroid storm? (if u have 2 ur at high risk)

A
  1. hyperpyrexia >41 degrees celcsius
  2. accelerated tachycardia / arrhythmia (arr. is the advanced version of tachy)
  3. cardiac failure
  4. delirium
  5. hepatocellular dysfunction / jaundice
28
Q

what are the treatment options for hyperthyroidism

A

surgery
drugs
radioiodine

29
Q

what are the categories of drugs use to treat hyper?

A

radioiodine
thionamides
potassium iodide
b blockers

30
Q

two options of thionamides

A

PTU - propylthiouracil
carbimazole (CBZ)

31
Q

what type of enzymes are the ones involved in the formation of thyroxine?

A

peroxidases

32
Q

what do peroxydases do?

A

they peroxydase iodine to form monoiodotYROSINE and DIT ect

33
Q

how do thionamides work

A

inhibit peroxydases

34
Q

do thionamides work for graves and toxic nodules?

A

yes

35
Q

how often do you need to take thionamides

A

daily

36
Q

when will thionamides start showing effects on patient?

A

weeks later because stored thyroxin needs to be used up first

37
Q

when is the biochemical effect of thionamides observed after administration?

A

immediately

38
Q

what will you give patients for short term relief

A

b- blockers - dont actually fix the problem only the symptoms - palpitaitons ect (its nervous system related)

39
Q

what type of b blocker do you need to give ( and give example of 1 specific drug)

A

NON selective b blocker ex. propanolol (bc the re are also some more advanced versions that are selective for heart)

40
Q

what is a risk of taking thionamides?

A

1/10,000 people will develop agranulocytosis: reduction of neutrophils: immunosupression very dangerous

41
Q

signs of agranulocytosis

A

sore throat and rashes

42
Q

management of agranulocytosis?

A

1)withdrawal of thionamides,
2)go to hospital, full blood count, if no white cells u go into side room bc u have no immune system
3) if sore throat give broad spectrum antibiotics
4) give you drugs to wake up your immune syst

43
Q

how long do you need to follow up with antithyroid drugs?

A

18 months

44
Q

what happens/ what do you do after 18 months of antithyroid treatmnet

A

you review patient periodically with thyroid function test: 50 % patients recover 50% relapse

45
Q

what do you do if they relapse?

A

surgery
radioiodine
or if they dont wnat hose lifetime carbinozole

46
Q

in what cases should you use iodine

A

1) before surgery
2) emergency treatment of thyroid storm

because it shuts down thyroid gland within 1-2 days

47
Q

as part of what compound do you usually give iodine

A

KI

48
Q

how do we think that Iodine works? (not been proven)

A

inhibition of thyroid hormone synthesis and secretion

1) inhibits iodination of thyroglobulin
2) inhibits H2O2 generation + thyroperoxidase

49
Q

when should you not give iodine

A

as a long term treatment option of graves disease because it stops having an effect after 10 days

50
Q

why iodine good for surgery

A

makes it smaller and less likely to bleed in surg within 10-14 days

stops tachycardia: also good for surg: better anesthesia

51
Q

possible side effects of surgery

A

risk of voice change
risk of parathyroid gland damage ( bad for bones ect)
scar
aneasthetic related risk s

52
Q

what are the two types of radioiodine you can give and for what 2 purposes

A

1) iodine 131 as a TREATMENT
2) iodine 99 Tc (pertechnetate) only for scans not as treatment

53
Q

what is the thing that should be considered when takinf radioiodine?

A

its radioactive, prgenanct moms shouldnr and also you need to avoid moms and chldren if ur taking it bc ur radioactive

54
Q

what is the best treatment rn according to NICE?

A

radioiodine

55
Q

what is a unique symptom of viral thyroiditis

A

neck pain

56
Q

what happens to stored thyroxine during the first month of viral thyroiditis?

A

it all gets used up

57
Q

why does all the stored thyroxine get used up?

A

because the virus prevents you from making any new thyroxine

58
Q

what does this mean for iodine uptake and scan images in viral thyroiditis?

A

NO IODINE uptake bc no new thyroxine synthesized and nothing lights up as black in scans

59
Q

what are the levels of TSH and Thyroxine in first month of viral thyroiditis?

A

t4 elevated tsh low

60
Q

what hapens to your blood thyroxine levels during the second month of viral thyroiditis and why

A

t4 levels fall below normal (hypothyroid) because all the stored thyroxine has been used and new thyroxine is still not made sufficiently

61
Q

how long after viral thyroiditis is slow recovery observed?

A

3 months

62
Q

what is postpartum thyroiditis ?

A

similar to viral but 1) no neck pain 2) is after pregnancy

63
Q

why does postpartum thyroiditis happen?

A

bc immune system is supressed during pregnancy and as it gets unsupressed after preg, thyroid gland becomes inflamed.

Endo yr 2 (11 decks)

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