Hyperthyroidsm Flashcards
(22 cards)
What is Graves’s Disease
An autoimmune condition where antibodies are produced that bind to TSH receptors on the thyroid gland causing a rise in hyperthyroidism and smooth goitre
Symptoms of Grave’s
Exophthalmos
Pretibial myxedema
Nervousness, excitability, restlessness
Tachycardia
Heat intolerance
Tremor
Diarrhoea
Oligo/Amenorrhoea
What causes exophthalmos?
Antibodies are produced that bind to muscles behind the eye
In extreme cases can lead to blindness
What causes pretibial myxedema?
Growth of soft tissue and swelling of the shins
Describe the appearance of the goitre in Graves’
It is a diffuse goitre and uniform radioiodine uptake
What is Plummers Disease and what is it also known as?
A benign adenoma that is overactive and releases thyroxine
Non autoimmune, don’t experience exophthalmos or pretibial myxedema
Known as toxic modular goitre
What are the effects of thyroxine in the SNS?
It sensitises the beta adrenoreceptors to ambient levels of adrenaline/noradrenaline
Too much causes lid lag, tachycardia, tremor
What are features of a thyroid storm?
Frank delirium
Hyperprexia
Increased tachycardia/arrhythmia
Cardiac failure
Hepatocellular dysfunction - jaundice
4 drug classes used to treat hyperthyroidism
Thionamides
Beta-blockers
Potassium Iodide
Radioiodine
Examples of thionamides and how they work
Propylthiouracil (PTU)
Carbimazole (CBZ)
They inhibit thyroid peroxidase so lesss T3/4 released
Distinguish between the time taken to see biochemical and clinical effects of thionamides
Biochemical effect - hours
Clinical effect - weeks because there are so many thyroxine stores; beta blockers can achieve the effects in the interim
Side effects of thionamides
Agranulocytosis & Rashes
When patient presents with a sore throat rather need immediate attention
Explain the use of KI
When KI is administered, there is the wolf-chaikoff effect, where the iodination of thrpyroglobulin is inhibited
HOWEVER, beyond 10 days the synthesis of T4 is stimulated again
In which context is KI given?
Prior to thyroid surgery
What are some issues with surgery?
Risk of voice changing if recurrent laryngeal nerve is touched
Risks of losing parathyroid glands
Scar
Anaesthetics
What is radioidone used for?
It us used in scans of the thyroid, it’s not a treatment
What are the implications of using radioiodine?
It’s contraindicated in pregnancy
Should avoid women with children and children
Patient becomes radioactive for 2 weeks
Medical name for inflammation of thyroid gland caused by viral infection?
Viral (de quervain’s) thyroiditis
Symptoms of viral thyroiditis?
Painful dysphagia
Pyrexia
Hyperthyroidism
Thyroid inflammation
Describe the progression of viral thyroiditis
Virus attacks thyroid glands and all T4 stores are released so patient becomes hyperthyroid and TSH drops - 1 month
T4 stores are exhausted so patient becomes hypothyroid - month 2
From this point onwards the patient slowly recovers and becomes euthyroid
Describe the radioiodine scan of a viral thyroiditis patient
No radioiodine uptake
Distinguish between viral thyroiditis and post-partum thyroiditis
Viral thyroiditis is painful
PPT doesn’t have pain and only occurs after pregnancy
