FN: Thyrotoxicosis Flashcards
Definition
The clinical effect of a high t4, usually form gland hyperfunction
Symptoms
Diarrhoea Increased appetite but wt. loss Sweats, heat intolerance Palpitations Tremor Irritability Oligomenorrhoea ± infertility
Signs: hands
Fast/irregular pulse
Warm, oist skin
Fine tremor
Palmer erythmea
Signs: face
Thin hair
Lid lag
Lid retraction
Signs: NEck
Goitre or nodules
Graves specific: opthalmology signs
Exophthalmos Opthalmoplegia: esp. up-gaze palsy Eye discomfort and grittiness Photophobia and grittiness Photophobia and reduced acuity Chemosis
Graves: Dermopathy
pre-tibilar myxoedema
Graves thyroid signs
Acropachy nails
General Investigations and findigns
- reduced TSH, raised t3/T4
- Abs: TSH receptor, TPO
- Raised Ca, raised LFTs
- Isotope scan (increased in graves, reduced in thyroiditis
- Opthalmopathy: acuity, fields, movements
Graves disease epi.
- 60% of cases of thyrotosicosis
- Prev: 0.5%
- Sex: F»M = 9:1
- Age: 40-60yrs
Graves features
- diffuse goitre with raised iodine uptake
- Opthalmopathy and dermopathy
- Triggers: stress, infection, child-birth
Graves associations
- T1DM
- Vitilgo
- Addisons
Other causes of thyrotoxicosis
- Toxic multinodular goitre = plummers disease
- Toxic adenoma
- Thyrotoxic phase of thyroiditis
- Drugs
Toxic multinodular goitre
Autonomous nodule develops on background multinodular goitre
Elderly and iodine - dificient areas
3. Iodine scan shows hot nodules
Toxic adenoma
Solitaryhot nodule producing T3/T4
Most nodules are non-functional
Thyrotoxic Phase of Thyroiditis
Hasimotos
de Quervains
Subacute lymphocytic
Drugs
Thyroxine
Amiodarone
Treatment medical
Symptomatic:Beta-blockers (e.g. propranolo 40mg/6h)
nti-thyroid: carbimazole (inhibits TPO)
Carbimazole
- titrae according to TFTs or block and replace
2. In graves’ Rx for 12-18mo then withdraw - 50% relapse –> surgery or radioiodine
Carbimazole SE
Agranulocytosis
Thyrotoxicosis radiological:
Radio-iodine
- Most become hypothyroid
- CI: pregnancy, lactation
Thyrotoxicosis: surgical
Thyroidectomy
Recurrent laryngeal N. damage
Hypoparathyroidism
Hypthryoidism
Thyroid storm features
raised temp agitation, confusion, coma Tachy, AF Acute abdomen HF
Thyroid storm precipitants
Recent thyroid surgery or radio-iodine
Infection
MI
Trauma
RX: thyroid storm
Fluid resuscitation +NGT
- Bloods: TFTs + cultures if infection suspected
- Propranolo PO/IV
- digoxin may be needed
RX: thyroid storm
Fluid resuscitation +NGT
- Bloods: TFTs + cultures if infection suspected
- Propranolo PO/IV
- Digoxin may be needed
- Carbimazole then lugols iodine 4h later to inhibit thyroid
- Hydrocortisone
- Rx cause
