HYPERTHYROIDISM

Question 1

where is thyroxine stored

Answer 1

in thyroglobulin in thyroid follicular cells

Question 2

what is the full name of T4

Answer 2

THYROXINE

Question 3

FULL NAME of t3

Answer 3

triiodothyronine

Question 4

how much thyroxine is approx stored in your thyroid any given moment (how long would you last with it)

Answer 4

1 month worth

Question 5

how does the pituitary help thyroxine formation

Answer 5

1) increases iodine uptake and oxidises it to inorganic
2) stimulates tsh

Question 6

what does TSH do exactly

Answer 6

goes down to thyroid follicular cells activates enzymes that trigger the release of stored thyroxine (t4) into blood

Question 7

where does t4 provide negative feedback?

Answer 7

pituitry AND hypothalamus

Question 8

thyroid related hormone released by hypothalamus and on what cells does it act

Answer 8

thyrotropin releasing hormone on thyrotrophs in anterior pit

Question 9

what happens to TSH levels when autoimmune hypothyroidism?

Answer 9

tsh goes up

Question 10

is graves disease autoimmune
hyper or hypothyroididsm

Answer 10

hyper

Question 11

mechanism of graves

Answer 11

TSH- receptor antibodies (TRAb) bind to and stimulate TSH receptor in thyroid

Question 12

symptoms of graves (ones i remember easily)

Answer 12

everything hyeprworking so:

visual:
- lid lag
-exophtalmos- cubbed fingers in severe exophtalmos cases

tempeprature and gastro:
- hot, flushing, hungry, eating more but losing weight, diarrhea

Question 13

other graves symptoms (ACRONYM: HERE) (harder)

Answer 13

HEART+ respiration: rapid pulse, palpitation, tachycarida, breathless

EMOTIONAL: nervousness excitsbiluty, restlessness, emotional instability, insomnia

REPROD: oligomenorrhea or amenorrhea

EXTERNAL: observable in appearance: localized myxedema, tremor, muscular weakness

Question 14

Mechanism of exophtalmos

Answer 14

antibodies bind to muscle behind the eyes

Question 15

what is pretibial myxoedema

Answer 15

non pitting oedema (you cant squish it in) in the shins in graves disease

Question 16

what does myxoedema refer to?

Answer 16

hypothyroidism

Question 17

what is the first line investigation to confirm graves disease

Answer 17

measuring TRABin blood

Question 18

what happens to the thyroid in graves disease

Answer 18

diffuse (omiomorfo) enlargement ( smooth goitre) and engorgement (bleeds very easily)

Question 19

how does graves disease thyroid look in radiology scan after giving radioiodine?

Answer 19

whole thing “lights up” in black

Question 20

does toxic nodular disease lead to hyper or hypothyroidism

Answer 20

hyperthyroidism

Question 21

2 categories of toxic nodular disease

Answer 21

single toxic nodul or multiple toxic nodules (multinodular goitre)

Question 22

what is the mechanism behind toxic nodular disease

Answer 22

benign adenomas that are overactive at making thyroxine

Question 23

how does toxic nodule disease look in radiology scan after giving radioiodine?

Answer 23

only hot nodule lights up in black

Question 24

by what mechanism does thyroxine act on the sympathetic nervous system?

Answer 24

sensitizes beta adrneoreceptors to ambient (surrounding) adrenaline and noradrenaline so activates symp nervous system

Question 25

what are the symptoms caused by the activation of the symp nervys system by thyroxine?

Answer 25

tachycardia, palpitations, tremor in hands, lid lag

Question 26

what is a thyroid storm, how do you react if you catch it?

Answer 26

when you are so hyperthyroid that it turns into a medical emergency, 50% mortality if untreated, treat it QUICKLY

Question 27

what are the alarm symptoms of htyroid storm? (if u have 2 ur at high risk)

Answer 27

1. hyperpyrexia >41 degrees celcsius 2. accelerated tachycardia / arrhythmia (arr. is the advanced version of tachy) 3. cardiac failure 4. delirium 5. hepatocellular dysfunction / jaundice

Question 28

what are the treatment options for hyperthyroidism

Answer 28

surgery drugs radioiodine

Question 29

what are the categories of drugs use to treat hyper?

Answer 29

radioiodine thionamides potassium iodide b blockers

Question 30

two options of thionamides

Answer 30

PTU - propylthiouracil carbimazole (CBZ)

Question 31

what type of enzymes are the ones involved in the formation of thyroxine?

Answer 31

peroxidases

Question 32

what do peroxydases do?

Answer 32

they peroxydase iodine to form monoiodotYROSINE and DIT ect

Question 33

how do thionamides work

Answer 33

inhibit peroxydases

Question 34

do thionamides work for graves and toxic nodules?

Answer 34

yes

Question 35

how often do you need to take thionamides

Answer 35

daily

Question 36

when will thionamides start showing effects on patient?

Answer 36

weeks later because stored thyroxin needs to be used up first

Question 37

when is the biochemical effect of thionamides observed after administration?

Answer 37

immediately

Question 38

what will you give patients for short term relief

Answer 38

b- blockers - dont actually fix the problem only the symptoms - palpitaitons ect (its nervous system related)

Question 39

what type of b blocker do you need to give ( and give example of 1 specific drug)

Answer 39

NON selective b blocker ex. propanolol (bc the re are also some more advanced versions that are selective for heart)

Question 40

what is a risk of taking thionamides?

Answer 40

1/10,000 people will develop agranulocytosis: reduction of neutrophils: immunosupression very dangerous

Question 41

signs of agranulocytosis

Answer 41

sore throat and rashes

Question 42

management of agranulocytosis?

Answer 42

1)withdrawal of thionamides, 2)go to hospital, full blood count, if no white cells u go into side room bc u have no immune system 3) if sore throat give broad spectrum antibiotics 4) give you drugs to wake up your immune syst

Question 43

how long do you need to follow up with antithyroid drugs?

Answer 43

18 months

Question 44

what happens/ what do you do after 18 months of antithyroid treatmnet

Answer 44

you review patient periodically with thyroid function test: 50 % patients recover 50% relapse

Question 45

what do you do if they relapse?

Answer 45

surgery radioiodine or if they dont wnat hose lifetime carbinozole

Question 46

in what cases should you use iodine

Answer 46

1) before surgery 2) emergency treatment of thyroid storm because it shuts down thyroid gland within 1-2 days

Question 47

as part of what compound do you usually give iodine

Answer 47

KI

Question 48

how do we think that Iodine works? (not been proven)

Answer 48

inhibition of thyroid hormone synthesis and secretion 1) inhibits iodination of thyroglobulin 2) inhibits H2O2 generation + thyroperoxidase

Question 49

when should you not give iodine

Answer 49

as a long term treatment option of graves disease because it stops having an effect after 10 days

Question 50

why iodine good for surgery

Answer 50

makes it smaller and less likely to bleed in surg within 10-14 days stops tachycardia: also good for surg: better anesthesia

Question 51

possible side effects of surgery

Answer 51

risk of voice change risk of parathyroid gland damage ( bad for bones ect) scar aneasthetic related risk s

Question 52

what are the two types of radioiodine you can give and for what 2 purposes

Answer 52

1) iodine 131 as a TREATMENT 2) iodine 99 Tc (pertechnetate) only for scans not as treatment

Question 53

what is the thing that should be considered when takinf radioiodine?

Answer 53

its radioactive, prgenanct moms shouldnr and also you need to avoid moms and chldren if ur taking it bc ur radioactive

Question 54

what is the best treatment rn according to NICE?

Answer 54

radioiodine

Question 55

what is a unique symptom of viral thyroiditis

Answer 55

neck pain

Question 56

what happens to stored thyroxine during the first month of viral thyroiditis?

Answer 56

it all gets used up

Question 57

why does all the stored thyroxine get used up?

Answer 57

because the virus prevents you from making any new thyroxine

Question 58

what does this mean for iodine uptake and scan images in viral thyroiditis?

Answer 58

NO IODINE uptake bc no new thyroxine synthesized and nothing lights up as black in scans

Question 59

what are the levels of TSH and Thyroxine in first month of viral thyroiditis?

Answer 59

t4 elevated tsh low

Question 60

what hapens to your blood thyroxine levels during the second month of viral thyroiditis and why

Answer 60

t4 levels fall below normal (hypothyroid) because all the stored thyroxine has been used and new thyroxine is still not made sufficiently

Question 61

how long after viral thyroiditis is slow recovery observed?

Answer 61

3 months

Question 62

what is postpartum thyroiditis ?

Answer 62

similar to viral but 1) no neck pain 2) is after pregnancy

Question 63

why does postpartum thyroiditis happen?

Answer 63

bc immune system is supressed during pregnancy and as it gets unsupressed after preg, thyroid gland becomes inflamed.