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A - MSRA Endocrinology [5] > [17] Thyrotoxicosis > Flashcards

[17] Thyrotoxicosis Flashcards

1
Q

What is thyrotoxicosis?

A

The clinical effect of increased T4, usually from gland dysfunction

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2
Q

What are the symptoms of thyrotoxicosis?

A 
Diarrhoea
↑ appetite but ↓ wt.
Sweats, heat intolerance
Palpitations
Tremor
Irritability
Oligomenorrhoea ± infertility
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3
Q

What are the hand signs of thyrotoxicosis?

A

Fast/irregular pulse
Warm, moist skin
Fine tremor
Palmar erythema

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4
Q

What are the face signs of thyrotoxicosis?

A

Thin hair
Lid lag
Lid retraction

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5
Q

What are the neck signs of thyrotoxicosis?

A

Goitre or nodules

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6
Q

What are the graves specific signs of thyrotoxicosis?

A

Opthalmopathy
Dermaopathy
Thyroid acropachy

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7
Q

What are the opthamology signs of Graves?

A 
Exopthalmos 
Opthalmoplegia, especially up-gaze palsy
Eye discomfort and grittiness
Photophobia and decreased acuity
Chemosis
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8
Q

What are the dermopathy signs of Graves?

A

Pre-tibial myxoedema

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9
Q

What investigations should be done in thyrotoxicosis?

A

Bloods
Antibodies
Isotope scan
Eye testing

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10
Q

What may be found on bloods in thyrotoxicosis?

A

Decreased TSH, increased T3/4
Increased calcium
Increased LFTs

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11
Q

What antibodies should be checked for in thyrotoxicosis?

A

TSH receptor

TPO

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12
Q

What may be found on isotope scan in thyrotoxicosis?

A

Increased in Graves’

Decreased in thyroiditis

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13
Q

What should be done on eye testing in thyrotoxicosis?

A

Acuity
Fields
Movements

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14
Q

What % of cases of thyrotoxicosis is caused by Graves?

A

60%

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15
Q

What is the male:female ratio of Graves?

A

M:F = 1:9

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16
Q

What age is Graves disease most common?

A

40-60 years

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17
Q

What are the clinical features of Graves disease?

A

Diffuse goitre with increased iodine uptake

Opthalmopathy and dermopathy

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18
Q

What are the triggers for Graves disease?

A

Stress
Infection
Childbirth

19
Q

What other conditions is Graves disease associated with?

A

T1DM
Vitiligo
Addison’s

20
Q

What are the other causes of thyrotoxicosis?

A

Toxic multinodular goitre
Toxic adenoma
Thyrotoxic phase of thyroiditis
Drugs

21
Q

What happens in a toxic multinodular goitre?

A

An autonomous nodule develops on a background of an multinodular goitre

22
Q

Where are toxic multinodular goitres common?

A

Elderly

Iodine deficient areas

23
Q

What does the iodine scan show in a toxic multinodular goitre?

A

Hot nodules

24
Q

What is a toxic adenoma?

A

A toxic hot nodule producing T3 and T4

25
Q

What conditions can cause a thyrotoxic phase of thyroiditis?

A

Hashimotos
De Quervain’s
Subacute lymphocytic thyroiditis

26
Q

What drugs can cause thyrotoxicosis?

A

Thyroxine

Amiodarone

27
Q

What is involved in the medical management of thyrotoxicosis?

A

Symptomatic management

Anti-thyroid drugs

28
Q

What can be used in the symptomatic management of thyrotoxicosis?

A

Beta blockers, e.g. propanolol 40mg/6 hours

29
Q

What anti-thyroid drug can be used in thyrotoxicosis?

A

Carbimazole

30
Q

What is the mechanism of action of carbimazole?

A

Inhibits TPO

31
Q

How should the dose of carbimazole be determined?

A

Titrate according to TFTs

Completely block, and replace with thyroxine

32
Q

How long should carbimazole be given in Grave’s disease?

A

12-18 months

33
Q

What % of patients relapse after 12-18 months of carbimazole treatment in Graves disease?

34
Q

What should be done if a patient relapses after 12-18 months in Graves disease?

A

Surgery or radioiodine

35
Q

What are the side effects of carbimazole?

A

Agranulocytosis

36
Q

What is involved in the radiological management of thyrotoxicosis?

A

Radio-iodine

37
Q

What happens following radioiodine treatment for thyrotoxicosis?

A

Most become hypothyroid

38
Q

What are the contraindications to radioiodine treatment in thyrotoxicosis?

A

Pregnancy

Lactation

39
Q

What is involved in the surgical management of thyrotoxicosis?

A

Thyroidectomy

40
Q

What are the potential adverse effects of thyroidectomy?

A

Recurrent larygneal nerve damage leading to voice hoarseness
Hypoparathyroidism
Hypothyroidism

41
Q

What are the features of a thyroid storm?

A 
↑temp
Agitation, confusion, coma
Tachycardia, AF
Acute abdomen
Heart failure
42
Q

What are the precipitants of a thyroid storm?

A

Recent thyroid surgery or radio-iodine
Infection
MI
Trauma

43
Q

How is a thyroid storm managed?

A
  1. Fluid resuscitation + NGT
  2. Bloods: TFTs + cultures if infection suspected
  3. Propranolol PO/IV
  4. Digoxin may be needed
  5. Carbimazole then Lugol’s Iodine 4h later to inhibit thyroid
  6. Hydrocortisone
  7. Rx cause

A - MSRA Endocrinology [5] (18 decks)

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