HYPERTHYROIDISM

Question 1

Causes of hyperthyroidism

Answer 1

Grave’s disease
Toxic multinodular goitre

Question 2

Symptoms of hyperthyroidism

Answer 2

Weight loss despite increased appetite
Excessive sweating
Heat intolerance
Tremors of the hands
Nervousness and irritability
Menstrual irregularity and sub-fertility

Question 3

Signs of hyperthyroidism

Answer 3

Staring gaze or protruding eyes
Tremors of the hands
Moist palms
Rapid pulse rate (which may be irregular)
Wide pulse pressure (High systolic BP with low diastolic BP e.g. 170/50 mmHg)
Heart failure
Goitre (often present but not always)

Question 4

Type of goitre in Grave’s disease

Answer 4

Smooth and diffuse

Question 5

Type of goitre in Grave’s disease

Answer 5

Smooth and diffuse

Question 6

Type of goitre seen in toxic multinodular goitre

Answer 6

Irregular

Question 7

Type of goitre seen in toxic multinodular goitre

Answer 7

Irregular

Question 8

Investigations in hyperthyroidism

Answer 8

Thyroid function tests - free T3, free T4, TSH
Thyroid ultrasound scan

Question 9

Investigations in hyperthyroidism

Answer 9

Thyroid function tests - free T3, free T4, TSH
Thyroid ultrasound scan

Question 10

Treatment objectives in hyperthyroidism

Answer 10

To reduce thyroid hormone levels in the blood to normal
To reduce symptoms associated with thyrotoxicosis
To prevent or treat complications

Question 11

Treatment objectives in hyperthyroidism

Answer 11

To reduce thyroid hormone levels in the blood to normal
To reduce symptoms associated with thyrotoxicosis
To prevent or treat complications

Question 12

First line treatment for hyperthyroidism

Answer 12

Carbimazole, oral,

Adults
20-40 mg daily

Children
3-18 years; 15 mg daily (adjusted according to thyroid hormone level)
< 2 years; not recommended

Question 13

Decrease dose of carbimazole when thyroid hormone levels are within the normal range and adjust doses subsequently according to ……… thyroid
function tests

Answer 13

Two monthly

Question 14

Second line treatment of hyperthyroidism

Answer 14

Propylthiouracil, oral,

Adults
100 mg 8 hourly

Children
12-18 years; 50-100 mg 8 hourly
5-12 years; 50 mg 8 hourly
1-5 years; 25 mg 8 hourly
1 month-1 year; initially 5-10mg/kg 8 hourly, Then 2.5-5 mg/kg 8 hourly based on thyroid hormone levels
< 1 month; 2.5-5 mg/kg 12 hourly

Question 15

When is PTU preferred

Answer 15

Pregnancy( especially in the first trimester)
Those who do not tolerate carbimazole

Question 16

Adjunct treatment of hyperthyroidism (to reduce symptoms of thyrotoxicosis)

Answer 16

Propranolol, oral,

Adults
10-40 mg 8 hourly (adjust dose till thyroid function)

Children
> 1 year; 1 mg/kg (max. 40 mg) 8 hourly

Neonates; 1 mg/kg 12 hourly

Question 17

Referral criteria in hyperthyroidism

Answer 17

Refer all cases not responding to conventional treatment to specialists in a secondary or tertiary hospital for further investigations and management.

Question 18

Referral criteria in hyperthyroidism

Answer 18

Refer all cases not responding to conventional treatment to specialists in a secondary or tertiary hospital for further investigations and management.