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Endocrine > hyperthyroidism and thyrotoxicosis > Flashcards

hyperthyroidism and thyrotoxicosis Flashcards

1
Q

Thyrotoxicosis

A

State when tissues are exposed to excess thyroid hormone

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2
Q

Primary Hyperthyroidism

A

Free T3/T4 high

TSH low

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3
Q

Secondary hyperthyroidism

A 
Free T3/T4 high 
TSH high (or 'normal')
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4
Q

Hyperthyroidism Aetiology

A

Excessive thyroid stimulation

  • Graves disease
  • Hashitoxicosis
  • Thyrotropinoma
  • Thyroid cancer
  • Choriocarcinoma

Thyroid nodules with autonomous function

  • toxic solitary nodule
  • Toxic multi nodular goitre
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5
Q

Thyrotoxicosis Aetiology

A

Causes of Hyperthyroidism

  • Excessive thyroid stimulation
  • Thyroid nodules with autonomous function

Thyroid inflammation (thyroiditis)

  • Subacute (de Quervains)
  • Post partum
  • Drug induced

Exogenous Thyroid Hormones

  • Over treatment with levothyroxine
  • Thyrotoxicosis factitia

Ectopic Thyroid tissue

  • Metastatic thyroid carcinoma
  • Struma Ovarii
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6
Q

Thyrotoxicosis Signs and Symptoms

A

Cardiac

  • Palpitation (AF)
  • Cardiac failure (very rare0

Sympathetic

  • Tremor
  • Sweating

CNS

  • Anxiety
  • nervousness
  • Irritability
  • sleep disturbance

GI
-frequent, loose bowel movements

Vision

  • liquid retraction
  • double vision (diplopia)
  • Proptosis (–> Graves)

Hair and skin

  • brittle, thin hair
  • Rapid fingernail growth

Reproductive
- Menstrual cycle changes (lighter bleeding and less frequency)

Muscle Weakness (esp, thighs and upper arms)

metabolism

  • Increased appetite
  • unintentional weight loss

Thermogenesis
-Intolerance to heat

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7
Q

Graves Disease Aetiology & Epidemiology

A

Interacting susceptibility genes plus environmental factors

Younger (20-50 years)

Smoking important

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8
Q

Graves Disease; Laboratory Investigations

A

Decreased TSH

Increased fT3/T4

hypercalcaemia and increase Alk Phos.
- increased bone turnover: Osteoporosis

Leucopenia (decreased WCC)

TSH receptor antibody (TRA b)

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9
Q

Specific Graves Clinical Signs

A 
pretibial Myxoedema 
Thyroid acropachy 
Smooth goitre 
Thyroid bruit
-Associated only with large goitres

Graves Eye Disease

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10
Q

Graves Eye Disease

A

Thyroid Eye Disease

Occurs in ~20% of patients with Graves

Associated with smoking

TRAb driven pathology

Treatment

  • Mild: Topical
  • Severe; Steroids, surgery
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11
Q

Nodular Thyroid Disease Presentation

A

Older patients. More insidious onset

Thyroid may feel nodular 
Asymmetrical goitre (smooth in graves)
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12
Q

Nodular Thyroid Disease Investigation

A

Increased fT3/T4
Decreased TSH

Antibody negative.

Scintigraphy: high uptake

Thyroid Ultrasound

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13
Q

Thyroid storm

A

Crisis
- Medical Emergency

Severe hypothyroidism

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14
Q

Thyroid storm features

A

Respiratory and cardiac collapse
Hyperthermia
Exaggerated reflexes

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15
Q

Thyroid Storm Treatment

A

may require mechanical ventilation

Lugols. iodine 
Glucocorticoids 
PTU
B-blocker
FLuids
Monitoring
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16
Q

Hyperthyroidism Treatment

A

Antithyroid drugs (ATDs)
Beta-blockers
Radioiodine
Thyroidectomy

17
Q

Antithyroid Drugs (ATDs) Mechanism

A

Inhibition of thyroid peroxidase (TPO) thereby blocking thyroid hormone synthesis

18
Q

ATD examples

A

Carbimazole

  • 1st line (once daily dosing)
  • Risk off aplasia cutis in early pregnancy

Propylthiouracil
-1st line in first trimester pregnancy

19
Q

ATD Side Effects

A

Generally well tolerated

Allergic Type Reactions (1-5%)

Liver

  • Increased risk of cholestatic jaundice
  • Increased liver enzymes
  • Fulminant hepatic failure

Agranulocytosis (0.1-0.5%)

  • Important to warn patient verbally and in writing to STOP drug and urgent FBC checked in event of fever, oral ulcer or oropharyngeal infection
  • ATDs cannot be used again
  • Risk highest in first 6 weeks
20
Q

beta- blockers mechanism and use

A

B-adrenoreceptor blockage, reduced activity of sympathetic nervous system

Propranolol is drug of choice

Useful for immediate symptomatic relief of thyrotoxic symptoms

21
Q

Radioiodine

A

1st line treatment in

  • Relapsed Graves disease
  • Nodular Thyroid disease
22
Q

Radioiodine contraindications

A

Contraindicated in pregnancy

Relatively contraindicated in active thyroid eye disease (can be used with steroid cover)

High risk of hypothyroidism in Graves

23
Q

Thyroidectomy

A

useful if radio iodine contraindicated

Will leave a scar

Surgical/ anaesthetic risks

  • recurrent laryngeal nerve palsy
  • hypothyroidism
  • hypoparathyroidism

Endocrine (25 decks)

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