Grave's Disease Flashcards
Is Grave’s disease primary/secondary hypo/hyper ____
primary hyperthyroidism
What is the pathophysiology of Grave’s disease?
Autoimmune condition: TSH receptor antibodies produced by immune system stimulating the TSH receptors on the thyroid gland triggering release of thyroid hormones.
What are classic signs of Grave’s disease?
Graves’ eye disease - exophthalmos / proptosis
Pretibial myxoedema
Thyroid acropachy (hand swelling and finger clubbing)
Diffuse goitre without nodules
What are more universal symptoms of hyperthyroidism?
Anxiety and irritability
Tachycardia
Sweating
Heat intolerance
Fatigue
Insomnia
Frequent loose stools
Sexual dysfunction
Brisk reflexes on examination
What are the levels of TSH and T4 in Grave’s disease?
Low TSH
High T4
What are the levels of TSH and T4 in secondary hyperthyroidism?
High TSH
High T4
What are the levels of TSH and T4 in subacute hypothyroidism?
High TSH
Normal T4
What are the levels of TSH and T4 in subacute hyperthyroidism?
Low TSH
Normal T4
How do you differentiate between Grave’s disease and TMG (toxic multinodular goitre)?
Ultrasound
See nodes if TMG otherwise Grave’s
How do you manage Grave’s disease
1st line: Carbimazole (either titration-block or block and replace using levothyroxine, not suitable in pregnancy)
2nd line: Propylthiouracil
Radioactive iodine - thyroid gland takes up and the emitted radiation destroys proportion of gland (not suitable in pregnancy)
Beta-blockers eg propranolol to block adrenalin-related symptoms.
Surgery thyroidectomy then levothyroxine.
There is a risk of acute p_____ with taking carbimazole
pancreatitis
There is a risk of severe l____ reactions with propylthiouracil
liver
What is a side effect of both carbimazole and propylthiouracil?
Agranulocytosis (low WBCs: neutrophils, eosinophils and basophils)
Vulnerable to infections
