Thyroid Flashcards
(25 cards)
Low Thyroid hormone: Hypothyroidism
High TSH
High Thyroid hormone: Hyperthyroidism
Low TSH
TSH
Takes time to adjust to a new level - 8 weeks
T4
Can be used to monitor treatment during the time that TSH is still adjusting
High Thyroid hormone: Causes
Can be due to other underlying conditions - need to treat this first
Thyroiditis
What is it, treatment
Inflammation of the thyroid gland
NSAIDs e.g Naproxen and short cause of steroids - treatment
Levothyroxine - not always, use to support NSAIDs
Beta blockers
Drugs affecting Thyroid: Causes Thyroiditis (ALSAI)
Amiodarone
Lithium
Sunitinib
Axitinib
Interferons
Drugs affecting Thyroid: Lowers TSH level (GD)
Glucocorticoids
Dopamine
Drugs affecting Thyroid: Causes Hypothyroidism
Lithium
Drugs affecting Thyroid: Causes Hyperthyroidism
Iodide
Drugs affecting Thyroid: Directly affecting thyroid gland
Amiodarone - can cause either hypo or hyper
Steroid therapy may be necessary
Hypothyroidism: Causes
Hashimoto’s disease - autoimmune destruction of thyroid glands
Hypothyroidism: Symptoms
Lethargy and tiredness
Cold intolerance
Weight gain
Dryness and coarsening of skin and hair
Hoarseness
Bradycardia
Goitre
Constipation
Hypothyroidism: Investigations
High TSH = Low T3 and T4
Hypothyroidism: Treatment
Levothyroxine 100-200mcg/day
30 - 60mins before breakfast, coffee, tea or other medication
Assess after 6 weeks - for TFTs to adjust
Severe Hypothyroid State: Treatment
Liothyronine Sodium IV - used for emergencies
10 - 20mcg - initially
60 mcg daily - increased to
Hyperthyroidism: Causes
Grave’s disease - autoimmune disease where antibodies attack TSH resulting to failed binding with its receptor
Hyperthyroidism: Symptoms
Weight loss
Increase appetite
Tremor
Heat intolerance
Palpitation / Tachycardia
Fatigue
Diarrhoea
Goitre
Irritability
Hyperthyroidism: Investigation
Low TSH = High T3 and T4
Hyperthyroidism: Treatment
Carbimazole 15 - 40mg daily - takes time to have an effect, start with high dose to control symptoms for 4 weeks
B-blockers e.g. Propanolol - used to provide rapid symptomatic control e.g. lowers HR
Prophylthiouracil 200 - 400mg - substitute
Agranulocytosis - rare complication
Hyperthyroidism: Blocking-replacement regimen
Give high dose of Carbimazole for 18 months + Levothyroxine
Hyperthyroidism: Radioactive Iodine
What is it, contraindications
Destroys a part of the gland
Second dose makes the gland underactive - subsequent hypothyroidism
Contraindicated in pregnancy while breast-feeding
Hyperthyroidism: Surgery
What is it, considerations, complications
TFTs should be normal before
Levothyroxine offered after
Complications e.g. hypothyroidism, hypocalcaemia, hypoparathyroidism - parathyroid gland may be removed during surgery due to its close promixity to thyroid gland
Hyperthyroidism: Monitoring after Surgery
Anti-thyroid drugs (ATD) - measure TFTs every 6 weeks. Measure every 8 weeks after course is finished
Radioactiove Iodine (RAI) - measure TFs every 6 weeks
Surgery - Measure TFTs at 2 and 6 months
