hypERthyroid

Question 1

primary vs secondary hyperthyroidism

Answer 1

primary - due to thyroid pathology

seocndary - due to pathology in hypothalamus or pituitary - producing too much TSH

Question 2

Graves disease

Answer 2

autoimmune thyroid disease
- body produces IgG antibodies to the TSH receptor

women 30-50yrs

Question 3

commonest cause of thyrotoxicosis

Answer 3

Graves

Question 4

Graves presentation

Answer 4

eye signs
- exophthalmos
- ophthalmoplegia

pretibial myxoedema

thyroid acropachy, triad;
1. digital clubbing
2. soft tissue swelling of hands+feet
3. periosteal new bone formation

Question 5

antibodies present in Graves

Answer 5

TSH receptor stimulating antibodies (90%)

anti-thyroid peroxidase antibodies (10%)

Question 6

Graves investigations

Answer 6

autoantibodies
thyroid scintigraphy
- diffuse
- homogenous
- increased uptake of radioactive iodine

Question 7

management of Graves

Answer 7

1st = anti-thyroid drugs - carbimazole (give if sx not controlled with propran)

propranolol = symptoms control

refer to 2nd care

Question 8

carbimazole complications

Answer 8

! Agranulocytosis !

Question 9

treatment with anti-thyroid drugs (ATD) such as carbimazole

Answer 9

started at 40mg, reduced gradually to maintain euthyroidism
- continued for 12-18months

Question 10

when is radioiodine treatment used? what are the contraindications

Answer 10

in patients who relapse following ATD therapy or resistant to ATD tx

contraindications
- pregnancy - avoid 4-6mths following
- age <16
- thyroid eye disease - may worsen

Question 11

amiodarone effect on thyroid

Answer 11

can cause both hypothyroidism + thyrotoxocosis

due to high iodine content

Question 12

subclinical hyperthyroidism

Answer 12

normal serum free thyroxine
with LOW TSH

Question 13

causes of subclinical hyperthyroidism

Answer 13

• multinodular goitre, esp in elderly females
• excessive thyroxine may give similar biochem picture

Question 14

complications of unrecognised subclinical hyperthyroidism

Answer 14

effect on -
- cardiovas - atrial fibrillation
- bone metabolism - osteoporosis

increase likelihood of dementia

Question 15

management of subclinical hyperthyroidism

Answer 15

often go back to normal - TSH levels must be persitently low to intervene

trial of low-dose antithyroid agent for 6 months to induce remission

Question 16

causes of thyrotoxicosis

Answer 16

• graves (50-60%)
• acute phase of de Querv thyroiditis, post partum or hashimotos
• amiodarone therapy
• contrast (iodinated contrast)
  –> tend to occur in elderlywith pre-exist thyroid probs

Question 17

TSH + T3/4 in thyrotoxicosis

Answer 17

TSH down
T4/3 up

Question 18

features of thyrotoxicosis

Answer 18

weight loss
heat intolerance
manic, restlessness
palpitations
sweating
tremor
pretibial myxoedema

Question 19

pretibial myxoedema

Answer 19

erythematous
oedematous lesions above lateral malleoli

Question 20

gynae changes in hyper vs hypo-thyroidism

Answer 20

hyper = oligomenorrhoea

hypo = menorrhagia

Question 21

thyroid storm

Answer 21

rare but life threatening cx of thyrotoxicosis
- seen in patients with well established thyrotoxicosis

NOT see in iatrogenic thyroxine excess

Question 22

thyroid storm precipitating events

Answer 22

thyroid/non-thyroid surgery
trauma
infection

acute iodine load - CT contrast

Question 23

thyroid storm presentation

Answer 23

fever >38.5
tachycardia
confusion, agitation
N+V
hypertension
heart failure
abnormal LFTs - jaundice

Question 24

mangement of thyroid storm

Answer 24

beta-blockers - IV propranolol
ATD - methimazole or propylthiouracil

decamethasone IV -> blocks conversion of T4-T3

Question 25

toxic multinodular goitre Ix + Mx

Answer 25

nuclear scintigraphy = patchy uptake

Mx = radioiodine therapy

Question 26

toxic multinodular goitre Ix

Answer 26

thyroid gland that contains a number of autonomously functioning thyroid nodules resulting in hyperthyroidism