Hyperthyroid Workup Flashcards
Investigations;
- TSH: Fully ?.
o Unless in the rare case of ? ?.
Free T3/T4: ?.
o Typically both ?, in rare cases there can be ‘T?-toxicosis’ with T? within the reference range.
TSH receptor antibody (?): sensitive and specific for ? .
—o Thyroid Peroxidase(TPO) is not elevated in all with Grave’ s, so no longer routinely used.
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Ix
? ? scan: if ? not present
o Can distinguish between ?, ? ? goitre, toxic ? or ?.
—• ? pattern of uptake in Graves’ disease.
—• One or more ‘?’ ? in toxic nodular goitre.
—• ?/? uptake in thyroiditis.
o ? scans can be used, but are less common.
?/? of the orbit: to assess extent of ?disease in ?
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Primary care;
Non-selective ? , e.g. ?.
o ?-?mg ?.d.s. for rapid relief of symptoms.
o May be the only treatment required for cases of ?.
Refer to a specialist endocrinologist.
o If symptoms are not controlled on ?, consider starting ? prior to specialist assessment
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Secondary care;
Patients with ? are usually offered an ? course of antithyroid therapy, with the hope of ? ?.
o Successful in ?% of cases, with ? or ‘?and ?’ regimens used for 6-? months.
o Titration regimens: start at a ? dose and titrate ? until the patient is ?.
o ‘Block and replace’: maintain a ? dose, and ? added back once ? levels are controlled.
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In other pathologies (not ?), antithyroid drugs control, but do not ? the disease.
o Patients are offered a choice of ? ? ? (RAI) therapy or ? management.
• RAI generally ? line.
• Drugs will always be used ? to RAI / surgery to render the patient ?-thyroid before definitive treatment.
o Antithyroid drugs may be used ? term if these therapies are unsuitable.
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Antithyroid drug therapy;
? is first line.
? is second line.
—o Due to risk of severe ? injury (1 in 10,000}.
Both act as a preferred substrate for thyroid ?, the key enzyme in thyroid hormone ?.
Both can also cause skin ?, or the more serious ?/?.
o Advise (including in ?) to see their GP immediately if they develop any signs of mouth ?, ? throat or ?.
Carbimazole can also cause ? ?.
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Radio-active iodine therapy;
131-I is used as first line in non-? pathology, or following failure of drug therapy in ?.
It is taken up by thyroid cells, and induces ? damage and cell death.
Anti-thyroid drugs must be discontinued prior to therapy for at least 1 ? to allow adequate uptake.
RAI is contraindicated in ?, and in active Grave’s ?.
o Can cause worsening of the ? symptoms.
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RAI
Patients should avoid prolonged contact with ? for ? weeks after treatment, and should not attempt to ? for six months.
Rarely, can ? cause ? of symptoms and thyroid ?.
There is no evidence of adverse effects on fertility, congenital malformations,
or incidence of non-thyroid cancer in people treated with radioiodine.
o Small ? risk of thyroid ?.
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Surgery;
Total or sub-total ?.
Surgery is indicated if the above measures have failed or are contraindicated if there is a suspicion of ?, or to manage a ? ? goitre.
Post-operative complications;
o ? formation causing ?.
—-• Emergency removal of ? required.
o ? (10%).
o ?: due to hypoparathyroidism (often ?).
o ? ? paresis: due to damage to the ? ? nerve.
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