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Year 3 Renal > Hyperthyroidism > Flashcards

Hyperthyroidism Flashcards

1
Q

What does TSH do?

A

Activates the uptake o iodine by the thyroid gland

Stimulates the production of thyroxine

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2
Q

How much Thyroxine do you store at once?

A

Enough for a whole month

So you can release it when it is required

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3
Q

How can thyroxine enter the blood stream from the thyroid gland?

A

Proteolytic enzyme forms a whole allowing thyroxine to enter the blood stream

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4
Q

What makes TRH?

A

Hypothalamus

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5
Q

What effects do T3 and T4 have on the pituitary and hypothalamus?

A

Negative

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6
Q

What level of TSH will you find in a patient wit primary hypothyroidism?

A

High TSH

Pituitary hormone tries to stimulate the production of Thyroxine since levels are low

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7
Q

How do we treat primary hypothyroidism?

A

Replacement by tablet
Increase does until TSH is normal
Will have to take for life
Once daily

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8
Q

What is the half-life of thyroxine?

A

10 days

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9
Q

Why is the half-life of thyroxine significant?

A

You can make up for missing a dose by taking a double dose

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10
Q

What is Graves’ disease?

A

Autoimmune
Antibodies bind to and stimulate the TSH receptor in the thyroid
Causes goitre (smooth) and hyperthyroidism

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11
Q

Give some symptoms of Graves

A 
Perspiration
Facial flushing
Muscle wasting
Shortness of breath
Breast enlargement
Expophthalmos
Goitre 
Palpitaiton
Increase appetite
Tremor
Localised myxoedema
Oligomenorrhea/Amenorrhea
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12
Q

Why do you get exophthalmos?

A

Antibodies bind to growth factor receptor antibodies on muscles
at the back of the eye

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13
Q

What is pretibial myxoedema?

A

Swelling on the shins of patients with graves disease: growth of soft tissue

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14
Q

What is myxoedema?

A

Auto-immune hypothyroidism

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15
Q

What is an iodine uptake scan?

A

Give radioactive iodine
Goes into thyroid
Can show thyroid size and uniform radio iodine uptake
Very black

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16
Q

What is Plummer’s disease?

A

Toxic nodular goitre
Not immune
Benign adenoma that is overactive at making thyroxine

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17
Q

How do you differentiate between Graves’ and Plummer’s?

A

No exophthalmos
NO pretibial myxoedema
Different iodine uptake scans (one side and more at salivary glands)

18
Q

What happens in Plummer’s disease?

A

Thyroid atrophies and shrinks away

Tumor is overactive

19
Q

What can Plummer’s disease be known as?

A

Toxic nodular goitre

Single hot nodule

20
Q

What are the effects of thyroxine on the sympathetic nervous system?

A

Sensitises beta adrenoreceptors to ambient levels of adrenaline and nor adrenaline

‘a bit of adrenaline goes a long way’

21
Q

What does the adrenaline cause?

A

The minute they try to be active they get tachycardia, palpitation, tremor in hands and lid lag

22
Q

What is lid lag?

A

Ask the patient to follow your finger

Eyelids are held back by adrenaline

23
Q

What did the patient present with?

A 
Weight loss despite increase appetite 
breathlessness
Palpitations
Tachycardia
Sweating
Heat intolerance
Diarrhoea
Lid lag and other sympathetic features
24
Q

What is a thyroid storm?

A

Medical emergency: 50% mortality untreated

Blood results confirm hyperthyroidism

25
Q

What are symptoms of a thyroid storm?

A 
Hyperpyrexia > 41 
Accelerated tachycardia / arrhythmia
cardiac failure
delirium / frank pschosis
haptocellular dysfunction ; jaundice
26
Q

What are treatment options for those with hyperthyroidism?

A

Surgery (thyroidectomy)
Radioiodine
Drugs

27
Q

What classes of drugs are used to treat hyperthyroidism?

A
  1. The thionamides (thiourylenes; anti-thyroid drugs)
    - propylthiouracil (PTU)
    - carbimazole (CBZ)
  2. Potassium Iodide
  3. Radioiodine
  4. β-blockers
28
Q

What is the mechanism of action of thionamide?

A

Inhibits TPO
Blocks synthesis of T3/T4
Due to stores they don’t get better for a month

29
Q

Why do you give the patient a beta-blocker with thionamide treatment?

A

Make them feel better whilst waiting for the thionamide to work

30
Q

What are the side effects of thionamide treatment?

A

Agranulocytosis (usually reduction in neutrophils) - rare and reversible on withdrawal of drug.
rashes (relatively common)

31
Q

What is the role of beta blockers in treating hyperthyroidism?

A

Several weeks for ATDs to have clinical effects e.g reduced tremor, slower heart rate, less anxiety

NON-selective (ie b1 & b2) b blocker
eg propranolol
achieves these effects in the interim

32
Q

When do you give potassium iodide?

A

preparation of hyperthyroid patients for surgery

severe thyrotoxic crisis (thyroid storm)

33
Q

What are the problems with thyroid surgery?

A

Risk of voice change
Risk of also losing parathyroid glands
Scar
Anaesthetic

34
Q

How do you give radioiodine?

A

Swallow a capsule containing about 370 MBq (10 mCi) of the isotope I (131)

Contraindicated in pregnancy

Need to avoid children and pregnant mums for a few days

For scans only (not treatment), 99-Tc pertechnetate is an option.

35
Q

Why must you isolate if you are taking radioiodine?

A

You emit radiation for 20 days

Must stay away from anyone who could be pregnant

36
Q

Summarise the treatment options?

A

Drugs:
Beta blockade is VERY IMPORTANT
propranolol

Anti thyroid drugs :
Carbimazole
Propylthiouracil

Surgery

Radioiodide

37
Q

What is viral thyroiditis?

A

Painful dysphagia
Hyperthyroidism
Pyrexia
Thyroid gland is visibly enlarged

38
Q

What happened in viral thyroiditis?

A

Stop iodine uptake and the thyroid makes more virus instead
NO uptake of iodine
All stored thyroxine released

Present with typical features of hyperthyroidism
4 weeks later when the stored thyroxine is exhausted you become hypothyroid

39
Q

Summaries the features of Viral (de Quervains) thyroiditis

A 
Neck becomes painful
All stored thyroxine released
Free T4 levels rise
TSH levels drop
1 month hyperthyroidism
But NO new thyroxine is being synthesised

Patient becomes hypothyroid – gland stops making thyroxine and just replicates virus
Hypothyroidism lasts a second month
After 3 months, there is slow recovery

40
Q

What is postpartum thyroiditis?

A

Similar to viral
but no pain only occurs after pregnancy
Immune system modulated during pregnancy

Year 3 Renal (7 decks)

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