hyperthyroidism

Question 1

what are the symptoms of thyroid storm/ hyperthyroid crisis?

Answer 1

• hyperthermia
• tachycardia
• jaundice
• altered mental state
• nausea and vomiting
• hypertension
• heart failure

Question 2

what are the precipitating factors for thyroid storm?

Answer 2

• seen in patients with established thyrotoxicosis

Precipitating events:
thyroid or non-thyroidal surgery
trauma
infection
acute iodine load e.g. CT contrast media

Question 3

what is the management of thyroid storm?

Answer 3

symptomatic treatment e.g. paracetamol
treatment of underlying precipitating event

first line:
beta-blockers: typically IV propranolol

then:
anti-thyroid drugs: e.g. methimazole or propylthiouracil

can be used, but at least 1hr (ideally 4) after antithyroid treatment:
Lugol’s iodine

dexamethasone - e.g. 4mg IV qds - blocks the conversion of T4 to T3

Question 4

what is acropathy and how does it relate to hyperthyroidism?

Answer 4

a feature of gives which is not present in other forms of thyrotoxicosis

thyroid acropachy, a triad of:
digital clubbing
soft tissue swelling of the hands and feet
periosteal new bone formation

Question 5

wha tare all the features seen in graves and not other thyrotoxicosis?

Answer 5

eye signs (30% of patients)
exophthalmos
ophthalmoplegia

pretibial myxoedema

thyroid acropachy, a triad of:
digital clubbing
soft tissue swelling of the hands and feet
periosteal new bone formation