thyroid - overactive

Question 1

bloods for subclinical hyperthyroid

Answer 1

normal free T3/4 // TSH < 0.1

Question 2

causes of subclinical hyperthyroid

Answer 2

multinodular goitre - esp elderly females

Question 3

complications subclinical hyperthyroid

Answer 3

AF, osteoporosis, dementia

Question 4

mx subclinical hyperthyroid

Answer 4

observe // trial low-dose Anti-thyroid for 6 months

Question 5

bloods in primary hyperthyroid

Answer 5

low TSH // high free T4

Question 6

bloods in secondary hyperthyroid

Answer 6

high TSH // high free T4

Question 7

general + GI + neuro symptoms hyperthyroid (7)

Answer 7

weight loss // restlessness // too hot // anxiety // tremor // diarrhoea

Question 8

cardio, skin, gynae, symptoms hyperthyroid

Answer 8

palpitations, tachycardia // high CO failure // sweating // pretibial myoxedema // clubbing // oligomenorrhoa

Question 9

what is pretibial myxoedema

Answer 9

red, oedema on lateral malleolus

Question 10

eye symptoms hyperthyroid

Answer 10

expothalamus (bulging) // conjunctival oedema // papilloedema // opthamloplegia // can’t close eyes

Question 11

RF developing thyroid eye disease

Answer 11

smoking // radioiodine

Question 12

what is deposited in the eye muscles in graves

Answer 12

glycosaminoglycan + collagen

Question 13

mx thyroid eye disease

Answer 13

lubricants // steroids // radio // surgery

Question 14

who should mx thyroid eye disease

Answer 14

deterioration of vision –> urgent optho

Question 15

causes thyrotoxicosis

Answer 15

graves // toxic nodular goitre // acute de Quervains or post-partum // amiodarone // contrast

Question 16

invx hyperthyroid

Answer 16

TSH // antibodies // iodine isotope scan

Question 17

most common cause hyperthyroid

Answer 17

graves

Question 18

who usually gets graves

Answer 18

women 30-50

Question 19

symptoms Graves

Answer 19

expothalamus, opththalmoplegia // pretibial myxoedema // thyroid acropachy - clubbing, soft tissue swelling, periosteal bone

Question 20

antibodies in graves

Answer 20

TSH (90%) TPO (75%)

Question 21

what is seen on thyroid scintigraphy of graves

Answer 21

diffuse, homogenous, increase uptake of radioactive iodine

Question 22

initial mx graves

Answer 22

propanolol to control symptoms

Question 23

who manages graves patients and what mx can be started in primary care

Answer 23

refer to endocrinologist (carbimazole can be given by GP if not controlled with propanolol)

Question 24

1st line ATD for hyperthyroid

Answer 24

carbimazole 40mg and reduce gradually for 12-18 months

Question 25

what drug is added in hyperthyroid when euthyroidism is met

Answer 25

thyroxine

Question 26

SE carbimazole

Answer 26

agranulocytosis // crosses placenta

Question 27

2nd line ATD hyperthyroid

Answer 27

Propylthiouracil

Question 28

when is radioiodine used in graves

Answer 28

relapse following ATD/ resistant

Question 29

contraindications radioiodine

Answer 29

pregnancy // <16 // (thyroid eye dease relative)

Question 30

SE radioiodine

Answer 30

hypothyroid

Question 31

what is toxic multinodular goitre cause

Answer 31

multiple thyroid nodules --> hyperthyroid

Question 32

nuclear scintigraphy toxic multinodular goitre

Answer 32

patchy uptake

Question 33

mx toxic multinodular goitre

Answer 33

radioiodine therapy

Question 34

what can cause thyroid storm

Answer 34

thyroid surgery // trauma // infection // iodine load eg CT contrast

Question 35

symptoms thyroid storm

Answer 35

fever >38.5 // raised HR // confusion + agitation // N+V // raised BP // HF // jaundice + LFTs

Question 36

mx thyroid storm (4)

Answer 36

IV propranolol // ATD eg methimazole or propylthiouracil // Lugols iodine // dexamethasone

Question 37

what causes subacute De Quervains thyroiditis

Answer 37

viral infection

Question 38

phases DeQuarvains thyroiditis

Answer 38

1 = 3-6 weeks of hyperthyroid, painful goitre // 2 = euthyroid // 3 = weeks - months hypothyroid

Question 39

what blood is raised in phase 1 subacute thyroiditis

Answer 39

ESR

Question 40

invx subacute thyroiditis

Answer 40

thyroid scintigraphy - reduced uptake of iodine 131

Question 41

mx subacute thyroiditis

Answer 41

self limitn // aspirin, NSAIDs, steroids