hyperthyroid

Question 1

causes?

Answer 1

graves’ disease (antibodies against TSH receptor)
toxic multinodular goiter
thyroid adenoma / cancer
hot nodule
drugs: amiodarone, lithium

Question 2

symptoms?

Answer 2

heat intolerance
weight loss despite high appetite
diarrhea
hyperreflexia
palpitations, A Fib, systolic HTN
anxiety, tremors
lid lag, lid retraction
MSK: hyperthyroid myopathy
oligomenorrhea

Graves’: exophthalmos, thyroid bruit, pretibial myxedema, thyroid acropachy

Question 3

diagnosis?

Answer 3

TFT, TSH receptor antibodies, thyroid scan, thyroid US

labs: hypercalcemia, hyperglycemia, high bilirubin

Question 4

treatment?

Answer 4

1. b blockers offers symptomatic relief for all patients
2. antithyroid drugs (methimazole, propylthiouracil causes agranulocytosis and hepatotoxicity)
   esp for thyroid storm, graves’, contraindication to radioactive iodine
3. radioactive iodine ablation
   esp for adenoma and TMG, failure of antithyroid drugs
   NOT FOR PREGNANT OR BREASTFEEDING
4. thyroidectomy

Question 5

thyroid storm define, presentation, treatment?

Answer 5

worsening of hyperthyroidism due to stress or stopping antithyroid drugs

present with fever, tachycardia, HTN, arrythmia and a fib possibly, then hypotension and shock, thyrotoxicosis, delirium altered mental status

tx: fluid resuscitation, give antipyretics, B blockers, propylthiouracil

what inhibits hormone synthesis: PTU
inhibits release: iodine solution given 1 hr AFTER ptu
inhibits conversion t4 to t3: BB, glucocorticoid