hyperthyroidism

Question 1

what is a type of hyperthyroidism

Answer 1

graves disease

Question 2

what is thyrotoxicosis

Answer 2

Thyrotoxicosis refers to the symptoms caused by the excessive circulation of thyroid hormones. It is typically caused by thyroid gland hyperactivity

Question 3

symptoms of thryotoxicis

Answer 3

fatigue, anxiety, heat intolerance, increased perspiration, palpitations, and significant weight loss despite increased appetite

Question 4

management of thryotoxicis

Answer 4

initial control of symptoms with beta blockers and antithyroid drugs, often followed by definitive therapy with either radioactive iodine ablation (RAIA) of the thyroid gland or surgery.

Question 5

what is an acute exacerbation of throtoxicosis called

Answer 5

life-threatening hypermetabolic state known as thyroid storm

Question 6

what do patients with thyroid storm require

Answer 6

Patients with thyroid storm require urgent stabilization in critical care settings with fluids, beta blockers, antithyroid medications (propylthiouracil, potassium iodide, and parenteral glucocorticoids)

Question 7

what is hyperthyroidsm

Answer 7

a condition characterized by the overproduction of thyroid hormones by the thyroid gland; can cause thyrotoxicosis

Question 8

what is graves disease

Answer 8

Acute to chronic hyperthyroidism

Question 9

what is the pathophysiology of hyperthyroidism

Answer 9

excess production of T3/T4 → compensatory decrease of TSH
Thyrotropic adenoma → ↑ TSH levels → ↑ T3/T4 levels

Question 10

symptoms of hyperthyroidism

Answer 10

weight loss, tachycardia. goiter

Question 11

how is thyroid function tested

Answer 11

Thyroid-stimulating hormone (TSH) level (initial screening test): Typically low/undetectable; a normal TSH level usually rules out hyperthyroidism.

Free T4 (FT4) and total T3 levels: Typically both elevated; indicated when thyrotoxicosis is strongly suspected or TSH is abnormal

Question 12

can raia cause a worsening of hyperthyroidism

Answer 12

yes

Question 13

what drug causes hyperthyroidism

Answer 13

amiadarone

Question 14

what does raia do

Answer 14

destroys hyroid gland

Question 15

what is the first line of antithyroid

Answer 15

carbimazole

Question 16

what is an alternative to carbimazole

Answer 16

Propylthiouracil

Question 17

which first line antithyroid had a slower moa

Answer 17

carbimazole

Question 18

what is the moa of carbimazole

Answer 18

preventing production of t4

Question 19

what is the moa of proplythiorucial

Answer 19

Prevents the production of T4 as well as preventing the conversion of T4 to T3
inside the cel

Question 20

how often should tfts be carried out

Answer 20

every 6 weeks then once every 3 months

Question 21

what monitoring needs to be done for propylthioracil

Answer 21

LFT as it can affects liver function tests

Question 22

what is the aim of hyperthyroidism?

Answer 22

aim of hyperthyroid treatment is to get the patient in a euthyroid state(normal thyroid)

Question 23

what is the titration dose regime for hyperthyroidism?

Answer 23

15-40mg OD until Euthyroid state is achieved then reduce to 5-15mg OD, dose
reduced gradually every 4 to 6 weeks. and therapy duration is normally for 12 to 18 months

Question 24

what is the risk of overtreatment with titration regime/

Answer 24

Overtreatment which can lead to hypothyroid state

Question 25

what is block replacement regime?

Answer 25

Give enough carbimazole to prevent thyroid hormone synthesis by the thyroid gland. Levothyroxine is also given to get TFT values back to normal.

Question 26

what is the disadvanatges of block regime

Answer 26

large number of tablets the patient needs to take more side effects because of high dose

Question 27

what are the adrs for anti thyroid drugs

Answer 27

agranulocytosis hepatoxicity acute pancreatitis

Question 28

symptoms of agranulocytosis

Answer 28

Fever - Sore throat mouth ulcers - Non-specific issues like bruising etc

Question 29

can pregnant women use radioactive iodine

Answer 29

cant be used if youre pregnant

Question 30

what is thyrotoxicosis

Answer 30

excess circulating thyroid hormones, irrespective of the source. (Thyrotoxicosis includes hyperthyroidism but thyrotoxicosis is not always caused by hyperthyroidism)

Question 31

what are the two types of Amiodarone Induced Thyrotoxicosis (AIT)

Answer 31

type 1 and type 2

Question 32

what is type 1 Amiodarone Induced Thyrotoxicosis (AIT)

Answer 32

due to excess of iodine present accelerate synthesis of new thyroid hormones secondary to the iodine load (75 mg/day, 10% iodide is released in plasma causing a 40 time increase iodine plasma concentration). occurs usually with people with underlying thyroid diseases

Question 33

what is type 2 Amiodarone Induced Thyrotoxicosis (AIT)

Answer 33

excess release of preformed T4 and T3 into the circulation (In type 2 AIT, destructive thyroiditis that results in excess release of preformed T4 and T3 into the circulation (11). It typically occurs in patients without underlying thyroid disease,

Question 34

how is type 1 Amiodarone Induced Thyrotoxicosis (AIT) treated

Answer 34

Thioamides (Propylthiouracil and Carbimazole /methimazole; PTU or CZ); possibly potassium perchlorate (to inhibit iodine uptake); lithium to reduce thyroid hormone synsthesis/release

Question 35

how is type 2 Amiodarone Induced Thyrotoxicosis (AIT)

Answer 35

glucocorticoids for anti-inflammatory and membrane-stabilizing effects (thioamides generally not recommended)

Question 36

how is graves disease viewed

Answer 36

Radioactive iodine solution. Will show an excess amount of iodine taken up by the thyroid gland.