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Endocrine SOH > Hyperthyroidism > Flashcards

Hyperthyroidism Flashcards

1
Q

Definition

A

Refers to conditions where there is over activity of the thyroid gland

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2
Q

Clinical features - general

A 
weight loss
increased appetite
fatigue
anxiety
Dry skin
Muscle weakness
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3
Q

Clinical features - hands

A

Tremor
Sweaty
Rapid fingernail growth

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4
Q

Clinical features - pulse

A

Tachycardic

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5
Q

Clinical features - eyes

A

Gritty
Double vision
Eye lid retraction

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6
Q

Clinical features - hair

A

Brittle

Thin

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7
Q

Clinical features - CNS

A

Irritability
Sleep disturbance
Heat intolerance

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8
Q

Clinical features - throat

A

Goitre

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9
Q

Clinical features - CVS

A

Palpitations

Cardiac failure

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10
Q

Clinical features - GI

A

Diarrhoea

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11
Q

Clinical features - reproductive

A

Oligomenorrhea

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12
Q

Management aim

A

Too much thyroid hormone is being produced so aim to block thyroid hormone synthesis, by blocking TPO

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13
Q

Management - first line

A

Carbimazole

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14
Q

Carbimazole - mechanism

A

Blocks the synthesis of new thyroid hormone by preventing iodine from attaching to thyroglobulin

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15
Q

Carbimazole - dosage

A

Daily

May take weeks to work - be patient

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16
Q

Carbimazole - side effects

A

Agranulocytosis

- risk is highest during first 6 weeks of treatment

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17
Q

Agranulocytosis

A

Absence of granulocytes/neutrophils in the blood which usually help to fight off infections.
Development of fever / throat infection / oral ulcer - stop carbimazole treatment immediately and get urgent FBC checked

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18
Q

Pt on carbimazole who then gets pregnant

A

Continue on carbimazole until 16 weeks and then switch to PTU

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19
Q

Pt pre-pregnant who is on carbimazole

A

Switch to PTU for first trimester

Switch to Carbimazole in 2nd and 3rd trimester

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20
Q

Propylthyouricil (PTU) - mechanism

A

Blocks the synthesis of new thyroid hormone by decreasing the conversion of T4 -> T3

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21
Q

PTU - use

A

Patient allergic/side effects from carbimazole

Pregnancy

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22
Q

Beta blockers - mechanism

A

Reduced activity of sympathetic nervous system

23
Q

Beta blockers - use

A

Immediate symptomatic relief

Doesn’t treat the disease itself

24
Q

Surgery

A

Sub-total thyroidectomy

25
Q

Radio-active iodine - use

A

Persistent disease

26
Q

Primary hyperthyroidism - definition

A

Disease affecting the thyroid gland itself

27
Q

Primary hyperthyroidism - thyroid function

A

Increased T3, T4 levels

Decreased TSH levels (to compensate - -ve feedback)

28
Q

Primary hyperthyroidism - investigations

A

Thyroid function tests
Auto-antibodies
- +ve : autoimmune
- -ve: do an US

29
Q

Primary hyperthyroidism - management

A

Carbimazole or PTU
Beta-blocker
Radio-active iodine
Surgery

30
Q

Primary hyperthyroidism - autoimmune condition

A

Grave’s disease

31
Q

Grave’s disease - definition

A

Autoimmune cause of hyperthyroidism

32
Q

Grave’s disease - who gets it?

A 
Younger patients (20-50) 
Mainly females
33
Q

Grave’s disease - cause

A

Genes

Environment - smoking

34
Q

Grave’s disease - pathogenesis

A

Lymphoid follicles present
Pale
Scalloping

35
Q

Grave’s disease - clinical features

A 
Described previously 
Pretibial myexoedema (red lumps / rash on leg) 
Thyroid acropachy (finger clubbing)
36
Q

Grave’s disease - thyroid eye disease

A

Proptosis - bulging of eyeballs
Lid lag
Opthalmoplegia - swelling of pre-orbital tissues

37
Q

Grave’s disease - auto-antibodies

A

TRAb
- if this is +ve, graves is highly likely and no need to image thyroid gland
Anti-TPO
Anti-thyroglobulin

38
Q

Grave’s disease - investigations

A

Auto-antibodies: TRAb +ve, Anti TPO +ve, Anti thyroglobulin +ve
Iodine uptake scan - increased uptake in both lobes
Doppler US
Increased alk phos

39
Q

Grave’s disease - management

A

Carbimazole, PTU
Mild: topical lubricants
Severe: steroids, radioactive iodine, surgery

Alternatively
Put patient on high dose carbimazole to make patient hypothyroid then correct this by putting them on thyroxine for 6 months

40
Q

Grave’s disease - management of relapsed disease

A

Radioactive iodine

41
Q

Secondary hyperthyroidism - definition

A

Disease affecting the hypothalamus or anterior pituitary gland
There is no thyroid gland pathology

42
Q

Secondary hyperthyroidism - thyroid function

A

Increased free T3, T4
Normal / increased TSH
- *if thyroid hormone levels are high, TSH levels should be low

43
Q

Subclinical hyperthyroidism - thyroid function

A

Normal free T3, T4 (these SHOULD be high)

Decreased TSH levels

44
Q

Subclinical hyperthyroidism - what condition is this associated with?

A

Multi-nodular goitre

45
Q

Severe hyperthyroidism - definition

A

Untreated / inadequately treated thyrotoxicosis

46
Q

Severe hyperthyroidism - who gets it

A

Grave’s patients with acute illness

Patients with recent thyroid surgery

47
Q

Severe hyperthyroidism - clinical features

A

Respiratory / cardiac collapse
Hyperthermia
Exaggerated reflexes

48
Q

Severe hyperthyroidism - management

A 
High dose carbimazole 
Beta blockers 
Hydrocortisone 
IV fluids 
Lugol's iodine
49
Q

Subacute thyroiditis (De Quervanin’s) - definition

A

Hyperthyroid –>
Hypothyroid –>
Normal

50
Q

Subacute thyroiditis (De Quervanin’s) - cause

A

Viral infection

51
Q

Subacute thyroiditis (De Quervanin’s) - clinical features

A

Fever
Viral symptoms
Neck tenderness

52
Q

Subacute thyroiditis (De Quervanin’s) - investigations

A 
Scintigraphy scan (low uptake throughout) 
Blood tests
53
Q

Subacute thyroiditis (De Quervanin’s) - management

A

Self limiting

54
Q

Drug induced thyroiditis - drugs involved

A

Lithium

Amiodarone

Endocrine SOH (25 decks)

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