Hyperthyroidism Flashcards Preview

Endocrinology > Hyperthyroidism > Flashcards

Flashcards in Hyperthyroidism Deck (43):
1

What are the hormone levels is primary hyperthyroidism?

TSH low
fT4 high
fT3 high

2

What are the hormone levels in secondary hyperthyroidism?

TSH high
fT4 high
fT3 high

3

What are the causes of hyperthyroidism?

Grave's disease
Iodine overdose
Drugs
Thyroiditis
Nodular

4

What is Grave's disease?

Autoimmune
Thyrotoxicosis

5

What is the etiology for Grave's disease?

F>M
20-50 years

6

What are the risk factors for Grave's disease

Viral trigger
Smoking
High iodine intake
Genetics/FHx

7

What is the prognosis of Grave's disease?

50% recover
50% relapse

8

What tests can you do for Grave's disease?

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

9

What are the signs of Grave's disease?

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

10

Why does pretibial myxoedema happen in Grave's disease?

pretibial accumulation of hydrophillic mucopolysaccharide at the dermis

11

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

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

12

What is a nodular cause of hyperthyroidism?

multinodular goitre
toxic nodule (adenoma)

13

What are sources of iodine overdose?

amiodarone
thyroxine
kelp supplements

14

What medications can cause hyperthyroidism?

lithium

15

What are the GI symptoms of hyperthyroidism?

frequent loose bowel movements

16

What are the gynae symptoms of hyperthyroidism?

lighter periods
oligomenorrhoea (less frequent periods)

17

What are the opthomogical symptoms of hyperthyroidism?

lid retraction
exopthalamus
diplopia
lid lag
chemosis
vision loss

18

What are the CNS symptoms of hyperthyroidism?

anxiety
irritability
sleep disturbance

19

What are the hair and nail changes in hyperthyroidism?

brittle hair
thin hair
Rapidly growing nails

20

What are the MSK symptoms of hyperthyroidism?

Muscle weakness (especially proximal limbs)

21

What are the metabolic changes in hyperthyroidism?

Weight loss
increased appetite

22

What are the thermogenic changes in hyperthyroidism?

heat intolerance

23

How does a nodular thyroid present?

insidious onset
older population
gland feels nodular
assymetrical goitre

24

What would antibody screening show in a nodular thyroid?

Antibody negative

25

What are the hormone levels with a nodular thyroid?

fT4/fT3 high
TSH low

26

What is De Quiveran's thyroiditis?

Subacute thyroiditis

27

What is the etiology of De Quiveran's?

F>M
20-50years

28

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

Viral trigger (associated viral symptoms eg sore throat)

29

What is the length of disease in De Quiveran's

Resloves in a few months

30

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

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

31

What are the hormone levels in sub-clinical hyperthyroidism?

Normal T3/T4
Low TSH
mildly overactive

32

What is the 1st line treatment for hyperthyroidism?

Carbimazole

33

What mechanism does carbimazole target?

Iodine attraction to tyrosine within thyroglobulin colloid

34

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

Pregnancy
use propylthiouracil (PTU)

35

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

Beta blockers
symptoms are sympathomemetic
therefore dulls down sympathetic response

36

How should Grave's disease be treated?

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

37

What treatments for hyperthyroidism would be considered after drug therapy?

Radioiodine
Surgery

38

What precautions does the patient have to take after radioiodine?

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

39

What are the risks of radioiodine treatment?

Hypothyroid
especially in Grave's

40

What are the risks of surgery in hyperthyroidism?

scar
recurrent laryngeal nerve palsy
anaesthetic risk
hypothyroid
hypoparathyroid

41

What are the complications of hyperthyroidism in pregnancy?

infertility
spontaneous miscarriage
stillbirth
thyroid crisis in labour
transient neonatal thyrotixicosis

42

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

N+V
tachycardia
warm
sweaty
lack of weight gain

43

How do you manage hyperthyroid in pregnancy?

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