Hyperthyroidism

Question 1

Thyrotoxicosis

Answer 1

Clinical effect of ↑T4, usually from gland

hyperfunction

Question 2

Symptoms of hyperthyroidism

Answer 2

Increased appetite 
Weight loss 
Increased bowel habits 
Sweating 
Palpitations 
Tremor and irritability

Question 3

Signs of hyperthyroidism

Answer 3

Hands:
Fast / irregular pulse
Warm, moist skin
Fine tremor
Palmer erythema

Face:
Thin hair
Lid retraction

Neck:
Goitre or nodules

Question 4

Signs of Grave’s disease

Answer 4

Exophthalmos
Eye discomfort and grittiness
Photophobia and ↓ acuity

Dermopathy: pre-tibial myxoedema

Question 5

Ix

Answer 5

Thyroid examination 
Cardiac examination 
Basic obs 
Bloods: FBC, TFTs, LFTs, 
Antibody tests - TSH receptor, TPO
Isotope scan

Question 6

Grave’s disease

Answer 6

IgG autoantibodies against the thyrotropin receptor. Activate the receptor, causing autonomous production of thyroid hormones

F>M 9:1

Diffuse goitre with ↑iodine uptake

Triggers: stress, infection, child-birth

Question 7

Grave’s associated disease

Answer 7

Other autoimmune conditions e.g. T1DM

Vitiligo
Addison’s disease

Question 8

Toxic Multinodular Goitre = Plummer’s Disease

Answer 8

Multiple nodules felt on thyroid

• Elderly and iodine-deficient areas
• Iodine scan shows hot nodules

Question 9

Toxic Adenoma

Answer 9

Solitary hot nodule ± producing T3/T4

Most nodules are non-functional

Question 10

Drugs that can cause hyperthyroidism

Answer 10

Amiodarone

Thyroxine

Question 11

Mx

Answer 11

Medical:
• Symptomatic: β-B
• Anti-thyroid: carbimazole (inhibits TPO)
• Graves’: carbimazole for 12-18mo then withdraw

Radiological: Radio-iodine

Surgical: Thyroidectomy

Question 12

S/E of radio-iodine

Answer 12

Hypothyroidism

CI: pregnancy, lactation

Question 13

Complications of thyroidectomy

Answer 13

Recurrent laryngeal N. damage → hoarseness
Hypoparathyroidism - Parathyroid gland disruption
Hypothyroidism

Question 14

Thyroid Storm

Answer 14

Severe thyrotoxicosis

Features:
• ↑ temp
• Agitation, confusion, coma
• Tachycardia, AF
• Acute abdomen
• Heart failure

Precipitants:
• Recent thyroid surgery or radio-iodine
• Infection
• MI
• Trauma

Question 15

Mx of thyroid storm

Answer 15

1. Fluid resuscitation + NGT
2. Bloods: TFTs + cultures if infection suspected
3. Propranolol
4. Digoxin may be needed
5. Carbimazole then Lugol’s Iodine 4h later to inhibit thyroid
6. Hydrocortisone
7. Treat cause