Term
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Definition
Causes hyperthyroidism
autoimmune condition due to production of abnormal immunoglobulin- TRAB thyroid antibodies which bind to thyroid receptor (mimicking TSH) |
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Term
| What is treatment of choice in mild goitre? |
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Definition
| Thionamides: propylthiouracil, methimazole, carbimazole |
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Term
| What is the mechanism of action of thionamides - propylthiouracil, methimazole, carbimazole? |
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Definition
Prevent thyroid synthesis by inhibiting the oxidation binding of iodide and its coupling to tyrosine
Decrease TRAB antibody levels |
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Term
| Why is carbimazole preferred over other thionamides? |
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Definition
Cheaper and less toxic than propylthiouracil
Single dose improves adherance
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Term
| When is propylthiouracil preferred over carbimazole? |
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Definition
During pregnancy; carbimazole cause congenital skin defects (aplasia cutis)
Give smaller doses of PTU, <300mg |
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Term
| What are most common adverse effects of thionamides? |
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Definition
Pruritic maculopapular skin rash
hepatitis
less common AE:
hypothromboinaemia
agranulocytosis |
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Term
| What should be monitored while taking thionamides? |
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Definition
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Term
| When is radioactive iodine (RAI) indicated to treat hyperthyroidism? |
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Definition
Post adolescent patients
Graves ophthalmopathy
History of thyroid surgery
Toxic nodular goitre
Old people with cardiac disease
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Term
| What is the most commonly used RAI |
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Definition
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Term
| What is the half life of I-131? |
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Definition
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Term
| What is pretreatment for RAI therapy? |
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Definition
Carbimazole for 1 month to deplete the gland of stored hormones.
OR
B-Blockers before and after RAI to prevent exacerbation of thyrotoxicosis |
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Term
| How long should before carbimazole should be ceased before RAI therapy? |
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Definition
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Term
| How long before RAI therapy should Propylthouracil be ceased? |
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Definition
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Term
| After what time can the maximum benefits of RAI treatment be seen? |
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Definition
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Term
| What is given to patients 3-5 days before surgery to reduce thyroid vascularity? |
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Definition
| KI tablets OR lugol's iodine |
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Term
| When is thyroidectomy indicated? |
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Definition
large goitres
when RAI and thionamides are C/I
respiratory distress
swallowing difficulties |
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Term
| How is amiodarone induced thyroxicosis treated? |
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Definition
high doses of glucocorticoids
prednisolone 20-25mg bd |
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Term
| What are the causes of hypothyroidism? |
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Definition
congenital
autoimmune (Hashimoto's)
drug induced/post operative
iodine deficiency
viral infection
Secondary: hypopituitarism/hypothalmic disease
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Term
| How is primary hypothyroidism diagnosed? |
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Definition
clinical assessment with thyroid hormones and TSH levels
low free T4 and T3, high TSH |
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Term
| How is secondary/tertiary hypothyroidism diagnosed? |
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Definition
clinical assessment with thyroid hormones and TSH levels
low free T4, low TSH |
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Term
| What are the symptoms of hypothyroidism? |
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Definition
Dry, flaky skin; yellow complexion
Dry, thinning hair
Puffy face and eyes
Slow speach/poor memory/depression
deepening, gruffness in voice
Increased serum LDL, macrocytic anaemia
Weight gain, decreased appetite
Bradycardia, cardiac enlargement |
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Term
| How is hypothyroidism treated? |
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Definition
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Term
| What are adverse effects of thyroxine long term treatment? |
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Definition
osteoporosis
atrial fibrillation |
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Term
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Definition
Severe, untreated hypothyroidism
Loss of conciousness and hypothermia
Requires hospitalisation |
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Term
| How is Myxoedema Coma treated? |
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Definition
Initial treatment with liothyronine (isomer of T3) 25mcg IV infusion
With or without loading dose of thyroxine 0.5-1mg oral
Also, fluid/electrolytes and glucocorticoid admin. maintained |
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Term
| What does the hyperparathyroidism cause? |
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Definition
| increase PTH -> bone mass loss -> hypercalcaemia |
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Term
| What are possible primary causes of hyperparathyroidism? |
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Definition
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Term
| What are possible secondary causes of hyperparathyroidism? |
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Definition
hypocalcaemia
hyperphosphataemia
chronic renal failure
metabolic disorders causing decreased Vit d |
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Term
| What are the pentad of symptoms associated with hyperparathyroidism? |
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Definition
Painful bones - arthralgias
Abdominal groans - N/V, anorexia
Psychic moans - OCD, depression
fatigue overtones
Kidney stones
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Term
| What is the treatment for symptomatic primary hyperparathyroidism |
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Definition
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Term
| What are the symptoms of hypoparathyroidism? |
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Definition
Musculoskeletal: twitching, tingling, hyperreflexia
Extrapyramidal symptoms
Paranoia
Arrhythmias, increased QT interval
Dry scaly skin |
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Term
| What is the treatment for hypoparathyroidism |
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Definition
Daily intake of 1000-2000mg of Ca2+
Vitamin D
Maybe phosphate binder |
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