Hyperthyroidism

Question 1

What are the causes of hyperthyroidism?

Which is the most common?

Answer 1

• Grave’s disease (most common)
• Toxic multinodular goitre
• Solitary toxic thyroid nodule
• De Quervain’s thyroiditis

Question 2

Describe the pathophysiology of Grave’s disease

Answer 2

Autoimmune hyperthyroidism caused by TSH receptor antibodies

Question 3

Describe the pathophysiology of toxic multinodular goitre

Answer 3

Multiple nodules develop on the thyroid gland which continuously produce excessive thyroid hormone (act independently of the normal feedback system)

Question 4

Give another name for toxic multinodular goitre

Answer 4

Plummer’s disease

Question 5

Describe the clinical features of hyperthyroidism

Answer 5

• Anxiety/irritability
• Sweating and heat intolerance
• Weight loss
• Frequent loose stools

Question 6

Describe the clinical features specifically associated with Grave’s disease

Answer 6

• Diffuse goitre
• Bilateral exophthalmos
• Pretibial myxoedema

Question 7

Describe the pathophysiology of De Quervain’s thyroiditis

Answer 7

Painful inflammation of the thyroid gland, triggered by a viral infection, e.g. flu. There is an initial hyperthyroid phase, followed by a hypothyroid phase

Question 8

Describe the clinical features of De Quervain’s thyroiditis

Answer 8

• Neck pain/swelling
• Dysphagia
• Features of hyperthyroidism

Question 9

Describe the management of De Quervain’s thryroiditis

Answer 9

This is a self-limiting condition so is managed supportively:

• NSAIDs for pain/inflammation
• Beta blockers for symptomatic relief of hyperthyroidism

Question 10

Describe the medical and surgical management of hyperthyroidism

(how can the medical management be classified into 2 categories?)

Answer 10

Medical mx (anti-thyroid drugs):

• Carbimazole (first-line)
• Propylthiouracil
• Radioactive iodine

Medical mx (symptomatic management):
- Beta blockers, e.g. propranolol

Surgery:
- Thyroidectomy/removal of toxic nodule(s)