Hyperthyroidism

Question 1

What is Hyperthyroidism?

Answer 1

The overprod of thyroid hormone by Thyroid gland

Question 2

What is Thyrotoxicosis?

Answer 2

Acc having too much thyroid hormone in the body

Question 3

What is Primary vs Secondary Hyperthyroidism?

Answer 3

Primary: problem in thyroid gland

Secondary: overstimulation by Thyroid Stimulating Hormone (TSH). Problem in Hyp / Pit

Question 4

What is Grave’s? (3 things)

Answer 4

1. AI condition
2. Immune system makes fake TSH antibodies --> overstimulate TSH receptors on Thyroid Gland –> Primary Hyperthyroidism
3. Most common cause of hyperthyroidism

Question 5

What is the HPA Axis for Thyroid Hormones?

Answer 5

Question 6

What are the Risk Factors for Hyperthyroidism? (3 things)

Answer 6

1. Female
2. Smoking
3. FHx (Grave’s)

Question 7

What are the causes of Hyperthyroidism? (5 things)

Answer 7

1. Grave’s (most common)
2. Toxic Multinodular Goitre (2nd most common)
3. Pituitary resistance to Thyroid hormone
4. TSH-secreting Pituitary Adenoma
5. Solitary toxic thyroid nodule (benign adenoma)

Question 8

What are the CF of Hyperthyroidism? (8 things)

Answer 8

1. Sweating
2. Weight loss
3. Emotional liability
4. Appetite increased / Anxiety
5. Tachycardia / Tremor
6. Intolerance to heat / Irregular mentruation
7. Nervousness
8. Goitre / Galoot (diarrhoea)

SWEATING

Hyperthyroidism, everything up up

Question 9

What are the unique CF of Grave’s? (3 things)

Answer 9

1. Exophthalmos (bulging eyes)
2. Goitre (without nodules)
3. Pre-tibial Myxoedema (non-pitting oedema on shins)

Question 10

What investigations should you do for sus Hyperthyroidism? (5 + 2 things)

Answer 10

1. TSH levels (LOW
2. T3 + T4 levels (HIGH)
3. FBC (Normocytic anaemia, aka low RBC of normal size)
4. Neutropenia (low WCC) (in Grave’s)
5. Antibodies (high in Grave’s)

Imaging (do if diagnosis still unclear)

1. RAIU (Radioactive iodine uptake)
2. Thyroid Doppler US

Question 11

What antibodies will you see in Grave’s?

Answer 11

Thyrotropin receptor antibodies (TRAb)

in particular: Thyroid-Stimulating Immunoglobulins

Question 12

What will a Radioactive iodine uptake (RAIU) scan show in Hyperthyroidism?

Answer 12

High iodine uptake = confirms Hyperthyroidism

Question 13

When should you do a Thyroid Doppler US instead of Radioactive iodine uptake (RAIU) scan?

Answer 13

Pregnancy

RAIU contraindicated in pregnancy

Question 14

What will a Thyroid Doppler US show in Hyperthyroidism? (3 things)

Answer 14

1. Diffuse enlargement
2. Solitary / multiple nodules
3. Increased blood flow in gland

Question 15

What are the management options for Hyperthyroidism? (4 things)

Answer 15

1. Anti-thyroid meds
2. Beta blockers
3. Radioactive Iodine
4. Surgery: Thyroidectomy

Question 16

What are the 2 strategies for Anti-Thyroid medications?

Answer 16

1. Titration
2. Block + Replace

Question 17

What is the “Titration” strategy of Anti-Thyroid medication of Hyperthyroidism?

Answer 17

Carefully titrating Anti-Thyroid meds to reach perfect levels of Thyroid hormones

Question 18

What is the “Block + Replace” strategy of Anti-Thyroid medication of Hyperthyroidism? (2 things)

Answer 18

1. Block: Big dose of Anti-Thyroid meds to completely block all Thyroid hormone production
2. Replace: Giving Levothyroxine as replacement for Thyroid hormones (titrated to effect)

Question 19

What is the FIRST LINE Anti-Thyroid medication for Hyperthyroidism?

Answer 19

Carbimazole

Question 20

What is the SECOND LINE Anti-Thyroid medication for Hyperthyroidism?

Why is it SECOND LINE?

Answer 20

Propylthiouracil

2nd line bc risk of:

Severe hepatic reaction –> death

Question 21

What is the use of Beta blockers in Hyperthyroidism?

Answer 21

To control adrenalin related symptoms of hyperthyroidism

Question 22

What is the best Beta blocker for Hyperthyroidism?

Why?

Answer 22

Propranolol

Bc is NON-selective Beta blocker

So works everywhere not jus heart

Question 23

How does Radioactive Iodine work to manage Hyperthyroidism? (4 things)

Answer 23

1. Pt drinks single dose of Radioactive Iodine
2. Taken up by Thyroid gland
3. Radiation destroys some of the Thyroid cells
4. Reduction in functioning cells –> less Thyroid hormone production

Question 24

What is a drawback of Radioactive Iodine / Thyroidectomy treatment for Hyperthyroidism?

Answer 24

Can leave pt Hypothyroid afterwards

–> Req Levothyroxine replacement therapy forever

Question 25

What are the strict rules of Radioactive Iodine treatment of Hyperthyroidism? (3 things)

Answer 25

1. Can't be pregnant / get pregnant for 6 months 2. Can't go near anyone for few days after dose 3. Can't go near kids / pregnant women for 3 weeks after dose

Question 26

What are the complications of Hyperthyroidism? (4 things)

Answer 26

1. Thyroid storm (life-threatening thyrotoxic crisis) 2. HF 3. Angina 4. AF