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Endocrinology Y2 > Hyperthyroidism > Flashcards

Hyperthyroidism Flashcards

1
Q

What causes Graves disease

A
  • Autoimmune

- Antibodies bind to and stimulate the TSH receptors in the thyroid

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2
Q

symptoms of Graves disease (4)

A
  • Cause goitre (large thyroid) (smooth) and hyperthyroidism
  • (Hyperthyroidism causes lid lag)
  • Other antibodies (which are also made in Graves’ disease) bind to muscles behind the eyes and cause exophthalmos
  • Other antibodies cause pretibial myxoedema (hypertrophy)
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3
Q

What is pretibial myxoedema

A

The (non-pitting) swelling that occurs on the shins of patients with Graves’ disease growth of soft tissue

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4
Q

What diseases are often the cause of hyperthyroidism

A

Graves’ disease

PLUMMER’S DISEASE:

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5
Q

What do we use to look at a thyroid gland, why does this work?

A

 Radioactive iodine scan Iodine is what thyroid hormones are produced from, so the radioactive iodine ends up collecting in the thyroid gland

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6
Q

What do we see in a radioactive iodine scan of a Graves’ patient

A

 We see the whole gland enlarge (smooth goitre)

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7
Q

What is the cause of Plummers disease

A
  • Benign adenoma that is overactive at making thyroxine
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8
Q

Difference in symptoms of Graves’ and Plummers? (3)

A
  • NO pretibial myxoedema This is usually an autoimmune feature
  • NO exophthalmos This is usually an autoimmune feature
  • Toxic nodular goitre
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9
Q

EFFECTS OF THYROXINE ON THE SNS?

A
  • Sensitises beta adrenoceptors to ambient levels of adrenaline and noradrenaline
  • Thus there is apparent sympathetic activation
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10
Q

Consequences of EFFECTS OF THYROXINE ON THE SNS? (4)

A

TACHYCARDIA, PALPITATIONS, TREMOR OF THE HANDS, LID LAG

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11
Q

Features of hyperthyroidism? (7)

A
  • Weight loss with increased appetite
  • Breathlessness
  • Palpitations, tachycardia
  • Sweating
  • Heat intolerance
  • Diarrhoea
  • Lid lag
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12
Q

Features of thyroid storm?

A
  • Hyperpyrexia (>41 degrees C)
  • Accelerated tachycardia/arrhythmia
  • Cardiac failure
  • Delirium/frank psychosis
  • Hepatocellular dysfunction; jaundice
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13
Q

HYPERTHYROIDISM TREATMENT OPTIONS (3)

A
  1. Surgery (thyroidectomy)
  2. Radioiodine
  3. Drugs
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14
Q

What types of drugs are used to treat hyperthyroidism? (4)

A
  1. THIONAMIDES (thiourylenes; anti-thyroid drugs)
    - Propylthiouracil (PTU)
    - Carbimazole (CBZ)
  2. POTASSIUM IODIDE
  3. RADIOIODINE
  4. BETA-BLOCKERS
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15
Q

Purpose of beta blocker use in hyperthyroidism?

A

aid symptoms

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16
Q

Examples of thionamides?

A
  • Propylthiouracil (PTU)

- Carbimazole (CBZ)

17
Q

Frequency of Admin for thionamides?

A

daily

18
Q

3 uses of thionamides?

A
  1. Daily treatment of hyperthyroid conditions
  2. Treatment prior to surgery - neoadjuvant
  3. Reduction of symptoms while waiting for radioiodine to act
19
Q

how do thionamides work

A

INHIBITING THYROPEROXIDASE

20
Q

What must happen before thionamides start working

A

NOT an immediate effect as you’ve already got thyroid hormone stored in the colloid so this must be used up

21
Q

What does thyroperoxidase do

A

Converts iodide to iodine to be used to make T3 and T4

22
Q

What is given short term to ease side effects of hyperthyroidism till the Thionamides kicks in

A

Beta blockers - propranolol

23
Q

UNWANTED ACTIONS of Thionamides? (2)

A
  • AGRANULOCYTOSIS (reduction in WBC count- usually neutrophils)- rare and reversible on withdrawal of drug
  • Rashes (relatively common)
24
Q

RoA of Thionamides?

A

Oral

25
Q
  • Carbimazole is an example of …
A

a Thionamides

26
Q

Propylthiouracil is an example of a ….

A

Thionamides

27
Q

What beta blocker is usually used in hyperthyroidism

A

PROPRANOLOL

28
Q

how does potassium iodide help with hyperthyroidism

A

A huge dose of iodide can be used to turn the thyroid gland off
You’d do this when you want to take effect quickly e.g. when a patient is about to go in for an operation and you want to get them under control before administration of general anaesthetic

29
Q

what is the wolf-Chaikoff effect

A

the temporary reduction in thyroid hormones following ingestion of large amounts of iodine

30
Q

Benefit of using KI as a neoadjuvant?

A

super quick compared to other thyroid drugs

31
Q

What would you give during a thyrotoxic crisis (thyroid storm)

A

KI and propranolol

32
Q

How does radioiodine work in hyperpituitarism

A
  • Attempts to stop all thyroid function Needs to be supplemented with thyroxine
  • Emits beta radiation, which destroys thyroid follicle cells
33
Q

VIRAL (DE QUERVAIN’S) THYROIDITIS is caused by?

A

Virus attacks thyroid gland

34
Q

Symptoms of VIRAL (DE QUERVAIN’S) THYROIDITIS

A
  • Painful dysphagia
  • Hyperthyroidism
  • Pyrexia
  • Raised ESR
35
Q

history of VIRAL (DE QUERVAIN’S) THYROIDITIS

A
  • Virus attacks thyroid causing pain and tenderness
  • Thyroid stops making thyroxine and makes viruses instead
  • Therefore, there is NO IODINE UPTAKE in radioiodine scans
36
Q

How long after initial viral arrack do you see hypothyroid symptoms of viral thyroiditis and why

A

4 weeks after

body will have run out of thyroid hormone

37
Q

Result of an iodine scan of a patient with viral thyroiditis?

A

No iodine uptake

Endocrinology Y2 (18 decks)

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