Endocrinology

Question 1

What are the various possible effects Amiodarone can have on thyroid function?

Answer 1

Amiodarone causes thyroid disturbance in 1 in 6 patients on it - can cause both hypo and hyper by increasing iodine levels

Amiodarone-induced hypothyroidism

Amiodarone-induced hyperthyroidism type I (direct result of excess iodine)-> goitre present -> treatment is Carbimazole or Potassium Perchlorate

Amiodarone-induced hyperthyroidism type 2 (a destructive thyroiditis) - NO goitre -> Tx is with steroids

Question 2

Which single antibody test is most useful in primary care to assess for Grave’s disease?

Answer 2

TRAbs - thyroid receptor antibodies
They are ~ 98% sensitive and specific to Grave’s

(whereas TPO is only present in ~ 70% of Graves cases)

Question 3

What is the typical presentation of postpartum thyroiditis and how is it usually managed?

Answer 3

Can present with biphasic picture ie initially hyper and then hypothyroid. Occurs in ~ 10% of women after birth.

Normally just treat symptomatically with a beta blocker for palpitation symptoms etc.