Hyperthyroidism

Question 1

What is hyperthyroidism?

Answer 1

Increased thyroid hormone synthesis and secretion from the thyroid gland

Question 2

What is thyrotoxicosis?

Answer 2

The clinical syndrome of excess circulating thyroid hormones

Question 3

What is the most common cause of hyperthyroidism?

Answer 3

Grave’s disease

Question 4

What is the 2nd most common cause of hyperthyroidism?

Answer 4

Multinodular goitre

Question 5

What is the 3rd most common cause of hyperthyroidism?

Answer 5

Solitary toxic nodule

Question 6

What are the causes of hyperthyroidism

Answer 6

• Grave’s disease
• Multinodular goitre
• Solitary toxic nodule
• Drugs
  Interferon, amiodarone
• Acute thyroiditis
• Gestational thyrotoxicosis

Question 7

What causes Grave’s disease?

Answer 7

Autoimmune process that causes Antibody stimulation of TSH receptor

Question 8

What is the most common cause of hyperthyroidism in the younger population?

Answer 8

Grave’s disease

Question 9

What are the risk factors for Grave’s disease?

Answer 9

• Females
• +ve family Hx
• Smoking
• Low iodine intake
• Other autoimmune diseases
• T1DM
• Pernicious anaemia
• Coeliac

Question 10

How may Grave’s disease present?

Answer 10

Diffusely symmetrical enlarged thyroid gland without nodules, and there may be a bruit

Question 11

What is a multinodular goitre?

Answer 11

Multiple thyroid nodules that become independent of TSH regulation

Question 12

What is the most common cause of hyperthyroidism in the older population?

Answer 12

Mulinodular goitre

Question 13

How may multinodular goitre present?

Answer 13

Non-tender, firm thyroid nodules

Question 14

What is solitary toxic nodule?

Answer 14

Solitary benign adenoma

Question 15

How may solitary toxic nodule present?

Answer 15

Unilateral, non-tender thyroid mass

Question 16

What is acute thyroiditis?

Answer 16

Inflammation of the thyroid gland which leads to release of thyroid hormones

Question 17

What symptoms are associated with acute thyroiditis?

Answer 17

• Fever
• Neck pain
• Tenderness
• Dysphagia

Question 18

How may acute thyroiditis present?

Answer 18

Tender, firm, irregular, diffusely enlarged thyroid gland which may be asymmetrical

Question 19

How does gestational thyrotoxicosis occur?

Answer 19

High concentrations of hCG can stimulate TSH receptors and suppress TSH

Question 20

When does gestational thyrotoxicosis occur?

Answer 20

1st Trimester

Question 21

What are the universal symptoms of hyperthyroidism?

Answer 21

• Anxiety and agitation
• Sweating
• Heat intolerance
• Tachycardia
• Weight loss despite good appetite
• Loss of libido
• Diarrhoea
• Fatigue

Question 22

What are the universal signs of hyperthyroidism?

Answer 22

• Palmar erythema
• Fine tremor
• Oncholysis
• Proximal myopathy
• Hyperreflexia
• Eyelid retraction
• Lid lag

Question 23

What are the signs only seen in Grave’s disease?

Answer 23

• Acropachy
• Pretibial myxoedema
• Eye disease:
  Proptosis/exophthalmos
  Ophthalmoplegia
  Oedema
  Double vision

Question 24

What is acropachy?

Answer 24

Soft tissue swelling of the hands and clubbing of the fingers

Question 25

What is pretibial myxoedema?

Answer 25

o Deposits of mucin under the skin in the pretibial area | o Discoloured, waxy, oedematous appearance to the skin

Question 26

What is Proptosis/exophthalmos?

Answer 26

Protrusion of eyeball

Question 27

What is eyelid retraction?

Answer 27

Sclera is visible above the superior corneal limbus

Question 28

What is the main risk factor of thyroid eye disease?

Answer 28

Smoking

Question 29

How do you treat thyroid eye disease?

Answer 29

- Steroids - Immunosuppression - Surgery

Question 30

What additional test would you order for Grave's disease?

Answer 30

TRAbs (TSH-receptor antibodies)

Question 31

What additional test would you order for thyroiditis?

Answer 31

ESR and CRP

Question 32

How do you treat hyperthyroidism?

Answer 32

- Propanolol - Antithyroid drugs = Carbimazole (1st), Propylthiouracil (2nd) Others: - Radioactive iodine - Thyroidectomy

Question 33

How can you give antithyroid drugs?

Answer 33

* Titration = start with high dose, and lower dose until lowest one is most effective * Block-replace = High dose of antithyroid drug until hypothyroidism, then you give levothyroxine as a replacement

Question 34

What do you need to warn a patient of when taking antithyroid meds?

Answer 34

• Agranulocytosis - Report signs of infection, especially a sore throat - WBC count should be performed - Drug stopped if evidence of neutropenia

Question 35

What can cause neonatal hyperthyroidism?

Answer 35

In Graves’ disease, thyroid stimulating antibodies can cross the placenta and stimulate the thyroid gland of the foetus

Question 36

What is a thyrotoxic crisis/ thyroid storm?

Answer 36

End of the spectrum of thyrotoxicosis and is characterised by compromised organ function

Question 37

How would you treat acute thyroiditis?

Answer 37

o Propranolol | Don’t need to give antithyroid medications

Question 38

What is type 1 amiodarone induced thyrotoxicosis (AIT)?

Answer 38

- Excess thyroid hormone synthesis - Enlarged goitre - Managed with carbimazole or potassium perchlorate - Stop amiodarone

Question 39

What is type 2 amiodarone induced thyrotoxicosis (AIT)?

Answer 39

- Amiodarone-related destructive thyroiditis - No Goitre - Corticosteroids - Stop amiodarone