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Endo > Hyperthyroidism > Flashcards

Hyperthyroidism Flashcards

1
Q

What is an autoimmune condition that causes hyperthyroidism?

A

Graves’ Disease

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2
Q

How does Grave’s disease cause hyperthyroidism?

A

Antibodies bind to and stimulate TSH receptors, cause an overproduction of thyroxine

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3
Q

What is the physical presentation of Grave’s disease?

A

Smooth diffuse goitre (not tender to touch) including thrill and bruit (hear blood rush), exophthalmos, pretibial myxoedema
increased BMR, body is overactive

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4
Q

How does exophthalmos work?

A

Antibodies bind to muscles behind the eye, causing eye to protrude forward

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5
Q

How does pretibial myxoedema work?

A

Antibodies bind to muscles in shin, causing growth of soft tissue

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6
Q

What is the difference between pretibial myxoedema and myxoedema?

A

Pretibial myxoedema is a sign of hyperthyroidism, myxoedema is an old name for hypothyroidism

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7
Q

How would you image a thyroid to test for Graves’ disease?

A

Inject radioactive iodine and perform a thyroid scan - should see a uniform smooth uptake of radioactive material to show an enlarged thyroid scan

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8
Q

How many antibodies associated with hyperthyroidism

A

3
- attached to thyroid gland (goitre)
- attached to eye muscles (exophthalmos)
- attached to shins (pretibial myxoedema)

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9
Q

What is a cancerous condition that causes hyperthyroidism? (benign)

A

Plummer’s Disease (aka toxic nodular thyroid disease)

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10
Q

How does this disease cause its effects?

A

Nodule growths (benign adenomas) overproducing thyroxine

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11
Q

Toxic nodular thyroid disease

A

Toxic nodular goitre,
no exophthalmos,
no pretibial myxoedema
Not an autoimmune disease

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12
Q

How does the shape of the thyroid gland change with toxic nodular goitre and what effect does this have on TSH&T4?

A

As one side grows (hypertrophy), the other side of the thyroid gland undergoes atrophy. This means a roughly standard amount of TSH&T4 will be released

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13
Q

What are the key features of a thyroid scan in toxic nodular thyroid disease?

A

A hot spot - one side will take up radioactive iodine, whereas the other side will not (atrophy) and hence will not show up on the scan.

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14
Q

How does thyroxine affect the sympathetic nervous system?

A

Thyroxine sensitises beta adrenoreceptors to adrenaline and noradrenaline - and has some sympathetic activation.

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15
Q

Therefore, what are some of the sympathetic effects found in hyperthyroidism?

A

Tachycardia, palpitations, sweating, tremor, lid lag (eye lid delayed in closing because of some sympathetic innervation)

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16
Q

What are the general symptoms of hyperthyroidism?

A

Weight loss, appetite increase, tiredness, heat intolerance, diarrhoea

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17
Q

What is a thyroid storm?
(thyrotoxic crisis)

A

When someone with a thyroid condition does not know about it and ignores it for a long time

18
Q

What heart condition can a thyroid storm lead to?

A

atrial fibrillation

19
Q

If a thyroid storm continues to be undetected, what is the percentage of mortality and what are the two main causes of mortality?

A

50% mortality, either profound hypotension (think tachycardia) or ventricular fibrillation

20
Q

What are 5 symptoms of a thyroid storm?
requires aggressive treatment

A

Hyperpyrexia (>41C),
arrhythmia,
cardiac failure,
jaundice,
delirium

21
Q

What are the 3 treatment types for hyperthyroidism?

A

Drugs, Radioiodine, Surgery (thyroidectomy)

22
Q

What are the 4 classes of drugs for hyperthyroidism?

A

Thionamides, inhibit enzyme sof the thyroid gland
Potassium Iodide, causes negative feedback within thyroid gland (short term)
Radioiodine (capsule)
Non-selective Beta Blockers

23
Q

Which drugs are anti-thyroid and which are symptom alleviators?

A

Non-selective beta blockers are symptom alleviators, thionamides/radioiodine/potassium iodide are anti-thyroid

24
Q

What are two types of thionamides?

A

Carbimazole,
PTU (propylthiouracil)

25
Q

What is the mechanism of action for thionamides?

A

Inhibit thyroid peroxidase and synthesis of T3/T4
takes a long time to work due to the months store of thyroxine

26
Q

What are the unwanted actions of thionamides?

A

agranulocytosis (low white blood cell count),
rashes

27
Q

What should be done if the more severe adverse effect occurs?

A

If agranulocytosis occurs, withdraw drug immediately

28
Q

How long do patients stay on drug treatment for?

A

18 months, then review periodically

29
Q

What symptomatic effects do beta blockers have?

A

Reduced tremors, slower heart rate, less anxiety

30
Q

What is an example of a non-selective beta blocker?

A

Propanolol
suppresses both B1 and B2

31
Q

When is potassium iodide typically used?

A

Severe thyrotoxic crisis and preparation for surgery

32
Q

What is the mechanism of action for potassium iodide?
Wolff-Chaikoff effect.

A

Inhibits iodination of thyroglobulin and prevents peroxide production

33
Q

Why would you give potassium iodide before surgery?

A

reduces in size, becomes firmer and does not bleed as easily

34
Q

What are two risks associated with surgery?

A

hoarse voice (damage to recurrent laryngeal nerve), parathyroid damage (leading to hypocalcaemia)

35
Q

What is a precaution people taking radioiodine should take? (best treatment)

A

Stay at home, avoid seeing pregnant women or children (particularly susceptible to radiation)

36
Q

What is viral thyroiditis and how does it work?

A
  • A viral infection (de Queraave’s) which attacks thyroid gland, releasing all stored thyroxine using the follicular cells to make viral components instead of more thyroxine
  • free T4 rises, TSH drops causing 1 month of hyperthyroidism with no new thyroxine
  • fT4 drops, TSH rises causing 1 month of hypothyroidism
  • resolution in 2-4 months
37
Q

What are specific symptoms patients report with viral thyroiditis?

A

Painful dysphagia (swallowing),
hyperthyroidism,
thyroid inflammation
pyrexia

38
Q

How do thyroxine levels change in viral thyroiditis?

A

Initially huge increase (all stored thyroxine is released), then a drop in the levels of thyroxine (as it is not being made), and then eventually stabilises

39
Q

How do TSH levels change in viral thyroiditis?

A

Initially a drop (as all stored thyroxine is released), and then an increase (when thyroxine isn’t being made), and then stabilises

40
Q

How will viral thyroiditis appear in a thyroid scan?

A

It will not - too occupied making viral components that it does not take in radioactive iodine

41
Q

What is another type of thyroiditis and when does it occur?

A

Post-partum thyroiditis after pregnancy

Endo (13 decks)

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