Hyperthyroidism

Question 1

What is hyperthyroidism?

Answer 1

High levels of thyroid hormone

Question 2

What is thyrotoxicosis?

Answer 2

High levels of thyroid hormone in the body

Question 3

What is primary hyperthyroidism?

Answer 3

Thyroid pathology with excessive thyroid hormone production but low TSH

Question 4

What is secondary hyperthyroidism?

Answer 4

Pituitary pathology with excessive TSH and therefore thyroid hormone production

Question 5

What is Plummers Syndrome?

Answer 5

Toxic multinodular goitre that grows on the thyroid gland and produces constant thyroid hormone

Question 6

What is De Quervains thyroiditis?

Answer 6

After a viral illness a period of time with hyperthyroidism followed by hypothyroidism before function returns to normal

Supportive treatment with NSAIDs and propranolol if needed

Question 7

What is thyroid storm?

Answer 7

Rare presentation of hyperthyroidism
Acute onset with fever, delirium and tachycardia
Requires hospital admission for monitoring and treatment
Treat as normal hyperthyroidism with supportive care and anti-arrhythmic medication if needed

Question 8

What is Graves disease?

Answer 8

Presence of TSI acting on thyroid gland causing excessive production of thyroid hormone

Question 9

What are the symptoms?

Answer 9

Weight loss
Anxiety
Heat intolerance
Loose stools
Amenorrhoea
Palpitations
Fatigue 
Increased appetite

Question 10

What are signs?

Answer 10

Tachycardia
Hypertension
Hyperreflexia
Warm peripheries
Goitre

Graves

• tibial myxoedema
• exophthalmos

Question 11

What investigations are needed?

Answer 11

Thyroid hormone levels

• Primary = TSH low and T3/4 raised
• Secondary = TSH, T3/4 raised

Technetium uptake scan

• large diffuse goitre= graves
• multinodular goitre= plummers syndrome
• single nodule= toxic nodular
• no uptake= thyroiditis

CT/MRI orbit if concerns about eye disease

TSH receptor antibodies in Graves disease

Question 12

What is the management?

Answer 12

Beta blocker e.g. propranolol for symptomatic relief

1) Carbimazole
- titrate dose or block and replace
- euthyroid in graves in 4-8wks
- remission in 18months

2) PTU
- can cause severe liver dysfunction so second line

3) Iodine uptake
- single dose taken, destroys cells to become euthyroid
- risk of becoming hypothyroid
- cannot get pregnant for 6 months
- cannot see children or pregnant people for 3wks
- avoid contact with people for a few days after dose

4) thyroidectomy
- definitive management
- will be hypothyroid
- risk of infection/ haematoma causing asphyxiation/ vocal cord palsy