Hyperthyroidism

Question 1

What is hyperthyroidism?

Answer 1

Where there is over-production of thyroid hormone by the thyroid gland

Question 2

What is thyrotoxocosis?

Answer 2

An abnormal and excessive quantity of thyroid hormone in the body

Question 3

Describe primary hyperthyroidism

Answer 3

due to thyroid pathology

Question 4

Describe secondary hyperthyroidism

Answer 4

the condition where the thyroid is processing excessive thyroid hormone as a result of overstimulation by TSH. This is from the pituitary or hypothalamus

Question 5

Describe Grave’s disease

Answer 5

an autoimmune condition where TSH receptor antibodies cause a primary hyperthyroidism. . These are abnormal antibodies produced by the immune system that mimic TSH and stimulate the TSH receptors. This is the most common cause of thyroid disease

Question 6

What is toxic multinodilar goitre also known as?

Answer 6

Plummer’s disease

Question 7

Describetoxic multinodilar goitre

Answer 7

a condition where nodules develop on the thyroid gland that act independent;y of the normal feedback system and continuously produce excessive thyroid hormone

Question 8

Describe exophthalmos?

Answer 8

the term used to describe bulging of the eyeball out of the socket caused by graves disease
This is due to inflammation and hypertrophy of the tissue behind the eyeball that pushes the eye forward

Question 9

Describe pretibial myxoedema

Answer 9

a dermatological condition where there are deposits of mucin under the skin on the anterior aspect of the leg. This gives a discoloured, waxy oedematous appearance to the skin over this area.
It is specific to grave’s disease and is a reaction to TSH receptor antibodies

Question 10

What are the universal features of hyperthyroidism?

Answer 10

anxiety and irritability
sweating and heat intolerance
tachycardia 
weight loss
fatigue 
frequent loose stools
sexual dysfunction

Question 11

What features are unique to grave’s disease?

Answer 11

Diffuse goitre (without nodules)
Graves eye disease
bilateral exopthalmos
Pretibial myxoedema

Question 12

What are the unique features of toxic multinodular goitre?

Answer 12

goitre with firm nodules
most patients over 50
second most common cause of thyrotoxicosis

Question 13

Describe a solitary toxic thyroid nodule and its treatment

Answer 13

this is where a single abnormal thyroid nodule is acting alone to release thyroid hormone. these are normally benign adenomas. They are treated with surgical removal of the adenoma

Question 14

Describe De Quervain’s thyroiditis

Answer 14

describes the presentation of a viral infection with fever, neck pain and tenderness, dysphagia and features of hyperthyroidism. There is a hyperthyroid phase followed by a hypothyroid phase as the TSH falls due to negative feedback.

Question 15

What is the management if De Quervain’s thyroiditis?

Answer 15

IT is self limited and is treated with NSAIDs for pain and inflammation and beta blockers for symptomatic relief for hyperthyroidism

Question 16

Describe a thyroid storm

Answer 16

A rare presentation of hyperthyroidism.
Also known as a thyrotoxic crisis.
Severe presentation with pyrexia, tachycardia and delirium.
Requires admission for monitoring and may need supportive care with fluids, anti-arrhythmic medications as well as beta-blockers

Question 17

What is the first line anti-thyroid drug?

Answer 17

Carbimazole

Question 18

What are the two strategies for carbimazole treatment?

Answer 18

Titration-block

block and replace

Question 19

Why is carbimazole preferred to propylthiouracil?

Answer 19

it is used in a similar way to carbimazole but there is a small risk of severe hepatic reactions, including death

Question 20

Describe radioactive iodine treatment

Answer 20

involves drinking a single dose or radioactive iodine
This is taken up by the thyroid gland and the emitted radiation destroys a proportion of the thyroid cells
This reduction in functioning cells results in a decrease of thyroid hormone production and this remission from hyperthyroidism. Remission can take 6 months and patients can be left hypothyroid afterwards and require levothyroxine replacement

Question 21

What are the rules for radioactive iodine treatment?

Answer 21

The patient:
must not be pregnant and not allowed to get pregnant for 6 months
must avoid close contact with children and pregnant women for 3 weeks
limit contact with anyone for several days after receiving the dose

Question 22

Describe beta-blockers in the management of hyperthyroidism

Answer 22

used to block the adrenalin related symptoms of hyperthyroidism propanolol is a good choice because it non-selectively blocks adrenergic activity (ie doesn’t just work on the heart)
do not treat the underlying problem but controls symptoms

Question 23

Describe the surgery for hyperthyroidism

Answer 23

To surgically remove the whole thyroid or thyroid nodules.

This effectively stops the production of thyroid hormone, patients will require levothyroxine replacement for life