FN: Thyrotoxicosis

Question 1

Definition

Answer 1

The clinical effect of a high t4, usually form gland hyperfunction

Question 2

Symptoms

Answer 2

Diarrhoea
Increased appetite but wt. loss
Sweats, heat intolerance
Palpitations
Tremor
Irritability
Oligomenorrhoea ± infertility

Question 3

Signs: hands

Answer 3

Fast/irregular pulse
Warm, oist skin
Fine tremor
Palmer erythmea

Question 4

Signs: face

Answer 4

Thin hair
Lid lag
Lid retraction

Question 5

Signs: NEck

Answer 5

Goitre or nodules

Question 6

Graves specific: opthalmology signs

Answer 6

Exophthalmos
Opthalmoplegia: esp. up-gaze palsy
Eye discomfort and grittiness
Photophobia and grittiness
Photophobia and reduced acuity
Chemosis

Question 7

Graves: Dermopathy

Answer 7

pre-tibilar myxoedema

Question 8

Graves thyroid signs

Answer 8

Acropachy nails

Question 9

General Investigations and findigns

Answer 9

1. reduced TSH, raised t3/T4
2. Abs: TSH receptor, TPO
3. Raised Ca, raised LFTs
4. Isotope scan (increased in graves, reduced in thyroiditis
5. Opthalmopathy: acuity, fields, movements

Question 10

Graves disease epi.

Answer 10

1. 60% of cases of thyrotosicosis
2. Prev: 0.5%
3. Sex: F»M = 9:1
4. Age: 40-60yrs

Question 11

Graves features

Answer 11

1. diffuse goitre with raised iodine uptake
2. Opthalmopathy and dermopathy
3. Triggers: stress, infection, child-birth

Question 12

Graves associations

Answer 12

1. T1DM
2. Vitilgo
3. Addisons

Question 13

Other causes of thyrotoxicosis

Answer 13

1. Toxic multinodular goitre = plummers disease
2. Toxic adenoma
3. Thyrotoxic phase of thyroiditis
4. Drugs

Question 14

Toxic multinodular goitre

Answer 14

Autonomous nodule develops on background multinodular goitre
Elderly and iodine - dificient areas
3. Iodine scan shows hot nodules

Question 15

Toxic adenoma

Answer 15

Solitaryhot nodule producing T3/T4

Most nodules are non-functional

Question 16

Thyrotoxic Phase of Thyroiditis

Answer 16

Hasimotos
de Quervains
Subacute lymphocytic

Question 17

Drugs

Answer 17

Thyroxine

Amiodarone

Question 18

Treatment medical

Answer 18

Symptomatic:Beta-blockers (e.g. propranolo 40mg/6h)

nti-thyroid: carbimazole (inhibits TPO)

Question 19

Carbimazole

Answer 19

1. titrae according to TFTs or block and replace

2. In graves’ Rx for 12-18mo then withdraw - 50% relapse –> surgery or radioiodine

Question 20

Carbimazole SE

Answer 20

Agranulocytosis

Question 21

Thyrotoxicosis radiological:

Answer 21

Radio-iodine

1. Most become hypothyroid
2. CI: pregnancy, lactation

Question 22

Thyrotoxicosis: surgical

Answer 22

Thyroidectomy
Recurrent laryngeal N. damage
Hypoparathyroidism
Hypthryoidism

Question 23

Thyroid storm features

Answer 23

raised temp
agitation, confusion, coma
Tachy, AF
Acute abdomen
HF

Question 24

Thyroid storm precipitants

Answer 24

Recent thyroid surgery or radio-iodine
Infection
MI
Trauma

Question 25

RX: thyroid storm

Answer 25

Fluid resuscitation +NGT

2. Bloods: TFTs + cultures if infection suspected
3. Propranolo PO/IV
4. digoxin may be needed

Question 26

RX: thyroid storm

Answer 26

Fluid resuscitation +NGT

2. Bloods: TFTs + cultures if infection suspected
3. Propranolo PO/IV
4. Digoxin may be needed
5. Carbimazole then lugols iodine 4h later to inhibit thyroid
6. Hydrocortisone
7. Rx cause