Hyperthyroidism

Question 1

What are the causes of hyperthyroidism

Answer 1

• Grave’s disease
• Toxic multi nodular goitre
• Amiodarone
• De Quervains (initial hyper T followed by longer hypoT)
• Post partum thyroiditis (initial hyper T followed by longer hypoT)
• Hashimoto’s (may get brief thyrotoxic phase initially)

Question 2

What are the symptoms of Graves

Answer 2

SWEATING:
Sweating
Weight loss
Emotional lability
A.Fib, appetite increase
Tremor/tachycardia
Irritability, intolerance to heat, irregular menses
Nervousness/restlessness (insomnia)
Goitre

Question 3

What symptoms are seen in Graves but not other types of hyperthyroidism

Answer 3

Smooth goitre
Exophthalmos
Pretibial myxoedema
Acropachy

Question 4

Who is most affected in graves

Answer 4

Women - middle aged. Smoking is also a risk factor

Question 5

What investigations should we do in someone with suspected hyperthyroidism

Answer 5

• TSH - should be low
• Serum fT4/T3 - should be high
• TSH receptor Abs - positive in 95% of Grave’s patients

Question 6

What is T3 toxicosis

Answer 6

When fT4 is normal but T3 is still elevated - this still qualifies for a diagnosis of hyperthyroidism

Question 7

What is subclinical hyperthyroidism

Answer 7

TSH is low however fT4/T3 are normal - can trial ATDs once persistently low TSH levels are established

Question 8

What is the management of Graves

Answer 8

1. Propranolol - manage adrenergic symptoms e.g. tremor, tachycardia
2. Refer to secondary care for ATDs - carbimazole given for 12-18 months to maintain euthyroid status
3. Radioiodine if refractory to treatment - given to prepare for surgery 10 days before
4. Surgery - total thyroidectomy if concerned about compression or malignancy

Question 9

What are the contraindications of radio iodine

Answer 9

• Pregnant women should avoid or those trying to get pregnant (need to wait 6 months)
• Children <16
• Thyroid eye disease (radioiodine worsens it)

Question 10

What is a thyroid storm

Answer 10

Rare but life threatening threatening complication where there’s a sudden significant rise in thyroxine - this may be triggered by trauma, infection or iodine contrast administration

Question 11

How does thyroid storm present

Answer 11

Fever
Profuse sweating
Diarrhoea
Haemodynamic instability
Delirium
Weakness
Seizure/coma
Jaundice
Hypothermia

Question 12

How do we manage thyroid storm

Answer 12

• IV propranolol
• ATDs
• Iodine
• Steroids - IV dexamethasone