Hyperthyroidism

Question 1

What causes Graves disease

Answer 1

• Autoimmune

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

Question 2

symptoms of Graves disease (4)

Answer 2

• 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)

Question 3

What is pretibial myxoedema

Answer 3

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

Question 4

What diseases are often the cause of hyperthyroidism

Answer 4

Graves’ disease

PLUMMER’S DISEASE:

Question 5

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

Answer 5

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

Question 6

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

Answer 6

 We see the whole gland enlarge (smooth goitre)

Question 7

What is the cause of Plummers disease

Answer 7

• Benign adenoma that is overactive at making thyroxine

Question 8

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

Answer 8

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

Question 9

EFFECTS OF THYROXINE ON THE SNS?

Answer 9

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

Question 10

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

Answer 10

TACHYCARDIA, PALPITATIONS, TREMOR OF THE HANDS, LID LAG

Question 11

Features of hyperthyroidism? (7)

Answer 11

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

Question 12

Features of thyroid storm?

Answer 12

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

Question 13

HYPERTHYROIDISM TREATMENT OPTIONS (3)

Answer 13

1. Surgery (thyroidectomy)
2. Radioiodine
3. Drugs

Question 14

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

Answer 14

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

Question 15

Purpose of beta blocker use in hyperthyroidism?

Answer 15

aid symptoms

Question 16

Examples of thionamides?

Answer 16

• Propylthiouracil (PTU)

- Carbimazole (CBZ)

Question 17

Frequency of Admin for thionamides?

Answer 17

daily

Question 18

3 uses of thionamides?

Answer 18

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

Question 19

how do thionamides work

Answer 19

INHIBITING THYROPEROXIDASE

Question 20

What must happen before thionamides start working

Answer 20

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

Question 21

What does thyroperoxidase do

Answer 21

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

Question 22

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

Answer 22

Beta blockers - propranolol

Question 23

UNWANTED ACTIONS of Thionamides? (2)

Answer 23

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

Question 24

RoA of Thionamides?

Answer 24

Oral

Question 25

- Carbimazole is an example of ...

Answer 25

a Thionamides

Question 26

Propylthiouracil is an example of a ....

Answer 26

Thionamides

Question 27

What beta blocker is usually used in hyperthyroidism

Answer 27

PROPRANOLOL

Question 28

how does potassium iodide help with hyperthyroidism

Answer 28

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

Question 29

what is the wolf-Chaikoff effect

Answer 29

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

Question 30

Benefit of using KI as a neoadjuvant?

Answer 30

super quick compared to other thyroid drugs

Question 31

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

Answer 31

KI and propranolol

Question 32

How does radioiodine work in hyperpituitarism

Answer 32

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

Question 33

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

Answer 33

Virus attacks thyroid gland

Question 34

Symptoms of VIRAL (DE QUERVAIN’S) THYROIDITIS

Answer 34

- Painful dysphagia - Hyperthyroidism - Pyrexia - Raised ESR

Question 35

history of VIRAL (DE QUERVAIN’S) THYROIDITIS

Answer 35

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

Question 36

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

Answer 36

4 weeks after | body will have run out of thyroid hormone

Question 37

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

Answer 37

No iodine uptake