Capsule cases - hyperthyroidism

Question 1

What would you find on examination of Graves? Specifically movement of the neck lump?

Answer 1

Smooth goitre that moves up with swallowing

Question 2

What might precipitate a thyrotoxic crisis?

Answer 2

Any acute stress on the body, e.g. infection, DKA, MI, hip replacement

Question 3

Symptoms

Answer 3

Diarrhoea 
Heat intolerance/hyperthermia 
Tremors
Tachycardia
Abdo pain 
Weight loss and muscle weakness (proteolysis) 
Rise in blood sugar levels 
Insomnia
In kids -> rapid growth 
Amennorhoea

Question 4

Why do you get the tachycardia?

Answer 4

Thyroid hormones sensitise some organs to catecholamines (increase in beta receptors)

Question 5

Symptoms of exopthalmos

Answer 5

Diplopia
Increased tear flow
Photophobia

Question 6

Signs

Answer 6

Smooth goitre with bruit
Hyperglyecemia
Hypercalcicuria & osteoporosis (bone metabolism increased) 
Exopthalmos 
Lid lag
Pretibial myxedema

Question 7

Features of a thyrotoxic storm

Answer 7

Hyperpyrexia
Accelerated tachycardia/arrhythmia
Cardiac failure
Delirium/frank psychosis
Hepatocellular dysfunction, jaundice

Question 8

Treatment for hyperthyroidism

Answer 8

Potassium iodide (Wolk-Chaikoff effect) 
-Lugol’s Solution or Aqueous iodine

Thionamides

• Propylthiouracil
• Carbimazole

Radioiodine

Question 9

Major side effect of carbimazole/propylthiouracil

Answer 9

Agranulocytosis = neutropenia

People get sore throats and mouth ulcers

Question 10

What would the blood tests show if there was non compliance with the thyroxine? What needs to be done?

Answer 10

High TSH
Normal fT4(as the pt often takes it just before a blood test)

Ask pt to take regularly
Repeat bloods in 6-8w