Hyper / Hypothyroidism

Question 1

Primary Hyperthyroidism
TFT

Answer 1

Thyroid gland over producing T3/T4 despite anterior pituitary reducing TSH.
T3/T4 HIGH
TSH LOW

Question 2

Secondary Hyperthyroidism
TFT

Answer 2

Rare (Usually adenocarcinoma)
Anterior Pituitary Gland producing too much TSH.

T3/T4 HIGH
TSH HIGH

Question 3

Causes hyperthyroidism

Answer 3

Graves disease
Toxic Mulinodular goitre
De-Quavains thyroiditis (aka subacute thyroiditis)
Amiodarone + Iodine
Post-Partum
IV Contrast

Question 4

Signs + Management of Hyperthyroid Emergency

Answer 4

Signs- Hyperthermia, tachycardia, confusion, N&V

Mx - Beta Blocker, Thionamide, iodine solution, steroids + ICU

Question 5

Subclinical Hypothyroidism
TFTs

Answer 5

TSH slightly elevated
T3/T4 low

Question 5

Treatment of subclinical hypothyroidism NICE guidelines

Answer 5

Not everyone needs treatment

TSH >10, T4/T3 normal range (X2, 3 months apart) consider treatment

TSH 5.5-10, T4/T3 normal range (x2, 3 months apart) and <65 + symptomatic - for 6 months

Older - W&W

Question 6

Treatment for Hypothyroidism

Answer 6

Cardiac disease + >60 then start 20-50mcg/day and increase every 6-8 weeks

<60 + no cardiac disease 1.6mcg/kg/day

Question 7

Treatment for hypothyroidism Pregnancy consideration

Answer 7

Increase treatment dose by 25-50mcg/day