Endocrinology 5 - Hyperthyroidism

Question 1

define primary vs secondary hyperthyroid

Answer 1

primary - thyroid itself secretes too much

secondary - pituitary or hypothalamus wrong, too much TSH

Question 2

Grave’s incl 4 x specific signs

Answer 2

most common hyperthyroid cause, TSHrAb

pretibial myoxoedema (discoloured, waxy shins)
exophthalmos
diffuse goitre
lid lag etc

Question 3

toxic multinodular goitre

Answer 3

second most common reason
act independently of feedback

goitre with firm nodules
usually over 50 years old

Question 4

7 features of hyperthyroidism

Answer 4

anxiety, irritability
sweating, heat intolerance
tiredness
tachycardia
weight loss
frequent diarrhoea 
sexual dysfunction

Question 5

explain De Quervain’s thyroiditis incl symptoms x 3

Answer 5

viral infection
fever, neck pain, dysphagia
+hyperthyroid symptoms

then moves to hypothyroid phase as feedback kicks in

self-limiting, NSAIDs and beta blockers sympto relief only

Question 6

define thyroid storm / thyrotoxic crisis

Answer 6

pyrexial
tachycardia
delirium

usually hyperthyroid background with some trigger e.g. meds stopped or bodily insult (rare)

need fluids, beta block, antiarrhythmics etc

Question 7

hyperthyroid drugs x 3 (bonus 1)

Answer 7

carbimazole (works in 4-8 weeks) either titrated or block and replace

propylthiouracil second line (risk of severe hepatic reaction)

radioactiv iodine single dose (can take 6 months and lead to remission, risk of hypoT)
avoid vuln contacts radiation

propanolol used often for sympto relief while drugs work, can just remove with surgery, depends on cause