Hyperthyroidism

Question 1

What are the hormone levels is primary hyperthyroidism?

Answer 1

TSH low
fT4 high
fT3 high

Question 2

What are the hormone levels in secondary hyperthyroidism?

Answer 2

TSH high
fT4 high
fT3 high

Question 3

What are the causes of hyperthyroidism?

Answer 3

Grave's disease
Iodine overdose
Drugs
Thyroiditis
Nodular

Question 4

What is Grave’s disease?

Answer 4

Autoimmune

Thyrotoxicosis

Question 5

What is the etiology for Grave’s disease?

Answer 5

F>M

20-50 years

Question 6

What are the risk factors for Grave’s disease

Answer 6

Viral trigger
Smoking
High iodine intake
Genetics/FHx

Question 7

What is the prognosis of Grave’s disease?

Answer 7

50% recover

50% relapse

Question 8

What tests can you do for Grave’s disease?

Answer 8

High T3/T4, Low TSH
Thyroid antibodies positive
Scintigraphy: high uptake/Ultrasound

Question 9

What are the signs of Grave’s disease?

Answer 9

Pretibial myxoedema (doughy)
Smooth symmetrical goitre
Lid retraction 
Lid lag
chemosis 
vision loss
diplopia
proptosis

Question 10

Why does pretibial myxoedema happen in Grave’s disease?

Answer 10

pretibial accumulation of hydrophillic mucopolysaccharide at the dermis

Question 11

What antibodies can you look for in Grave’s disease?

Answer 11

Anti TPO (70-80%)
Anti TG (30-50%)
TSH receptor antibody (70-100%)-stimulating

Question 12

What is a nodular cause of hyperthyroidism?

Answer 12

multinodular goitre
toxic nodule (adenoma)

Question 13

What are sources of iodine overdose?

Answer 13

amiodarone
thyroxine
kelp supplements

Question 14

What medications can cause hyperthyroidism?

Answer 14

lithium

Question 15

What are the GI symptoms of hyperthyroidism?

Answer 15

frequent loose bowel movements

Question 16

What are the gynae symptoms of hyperthyroidism?

Answer 16

lighter periods

oligomenorrhoea (less frequent periods)

Question 17

What are the opthomogical symptoms of hyperthyroidism?

Answer 17

lid retraction
exopthalamus
diplopia 
lid lag
chemosis
vision loss

Question 18

What are the CNS symptoms of hyperthyroidism?

Answer 18

anxiety
irritability
sleep disturbance

Question 19

What are the hair and nail changes in hyperthyroidism?

Answer 19

brittle hair
thin hair
Rapidly growing nails

Question 20

What are the MSK symptoms of hyperthyroidism?

Answer 20

Muscle weakness (especially proximal limbs)

Question 21

What are the metabolic changes in hyperthyroidism?

Answer 21

Weight loss

increased appetite

Question 22

What are the thermogenic changes in hyperthyroidism?

Answer 22

heat intolerance

Question 23

How does a nodular thyroid present?

Answer 23

insidious onset
older population
gland feels nodular
assymetrical goitre

Question 24

What would antibody screening show in a nodular thyroid?

Answer 24

Antibody negative

Question 25

What are the hormone levels with a nodular thyroid?

Answer 25

fT4/fT3 high | TSH low

Question 26

What is De Quiveran's thyroiditis?

Answer 26

Subacute thyroiditis

Question 27

What is the etiology of De Quiveran's?

Answer 27

F>M | 20-50years

Question 28

What are the risk factors for developing De Quiveran's?

Answer 28

Viral trigger (associated viral symptoms eg sore throat)

Question 29

What is the length of disease in De Quiveran's

Answer 29

Resloves in a few months

Question 30

What is the hormone level profile in De Quiveran's?

Answer 30

Euthyroid (normal T3/T4) Hyperthyoid (High T3/T4) Hypothyroid (Low T3/T4) Euthyroid (normal T3/T4)

Question 31

What are the hormone levels in sub-clinical hyperthyroidism?

Answer 31

Normal T3/T4 Low TSH mildly overactive

Question 32

What is the 1st line treatment for hyperthyroidism?

Answer 32

Carbimazole

Question 33

What mechanism does carbimazole target?

Answer 33

Iodine attraction to tyrosine within thyroglobulin colloid

Question 34

When should carbimazole not be used and what should be used instead?

Answer 34

``` Pregnancy use propylthiouracil (PTU) ```

Question 35

What other drugs should be used to manage symptoms of hyperthyroidism and why?

Answer 35

Beta blockers symptoms are sympathomemetic therefore dulls down sympathetic response

Question 36

How should Grave's disease be treated?

Answer 36

Carbimazole High dose over 12-18months Then stop treatment to prevent hypothyroid

Question 37

What treatments for hyperthyroidism would be considered after drug therapy?

Answer 37

Radioiodine | Surgery

Question 38

What precautions does the patient have to take after radioiodine?

Answer 38

avoid long contact with children or pregnant women Don't share a bed with someone else Avoid pregnancy for 6 months Ensure not pregnant

Question 39

What are the risks of radioiodine treatment?

Answer 39

Hypothyroid | especially in Grave's

Question 40

What are the risks of surgery in hyperthyroidism?

Answer 40

``` scar recurrent laryngeal nerve palsy anaesthetic risk hypothyroid hypoparathyroid ```

Question 41

What are the complications of hyperthyroidism in pregnancy?

Answer 41

``` infertility spontaneous miscarriage stillbirth thyroid crisis in labour transient neonatal thyrotixicosis ```

Question 42

How is it difficult to distinguish hyperthyroidism from nausea in pregnancy?

Answer 42

``` N+V tachycardia warm sweaty lack of weight gain ```

Question 43

How do you manage hyperthyroid in pregnancy?

Answer 43

Wait and see (supportive) B blockers in early pregnancy LOW DOSE PTU 1/3 Carbimazole 2/3