Hyperthyroidism

Question 1

What is thyrotoxicosis?

Answer 1

Abnormal and excessive quantity of thyroid hormomes (due to any cause)

Question 2

What is subclinical hyperthyroidism?

Answer 2

T3 and T4 levels are normal, but TSH is suppressed

Question 3

What is the most common cause of primary hyperthyroidism?

Answer 3

Graves’ disease

Question 4

What are the causes of hyperthyroidism?

Answer 4

GIST
G - graves’ disease
I - inflammation
S - solitary toxic thyroid nodule
T - toxic multinodular goitre

Question 5

What clinical picture does thyroiditis often present with?

Answer 5

Causes an initial period of hyperthyroidism, followed by under-activity of the thyroid gland

Question 6

What are the causes of thyroiditis?

Answer 6

De Quervian’s thyroiditis
Hashimoto’s thyroiditis
Postpartum thyroiditis
Drug-induced thyroiditis

Question 7

What is the presentation of hyperthyroidism?

Answer 7

Anxiety and irritability
Sweating and heat intolerance
Tachycardia
Weight loss
Fatigue
Insomnia
Frequent loose stools
Sexual dysfunction
Menstrual irregularity

Question 8

What are the signs specific to Graves’ disease?

Answer 8

Diffuse goitre
Graves’ eye disease including exophthalmos
Pretibilar myxoedema
Thyroid acropachy

Question 9

What investigations are used in the diagnosis of hyperthyroidism?

Answer 9

TFTs - first line
Antibodies - anti-TSH receptor positive in patients with Graves’ disease

Thyroid ultrasound
Technetium radionuclide scan
ECG - AF

Question 10

What TFT results will be seen in primary hyperthyroidism?

Answer 10

High T4
Low TSH

Question 11

What TFT results will be seen in subclinical hyperthyroidism?

Answer 11

Normal T4
Low TSH

Question 12

What TFT results will be seen in secondary hyperthyroidism?

Answer 12

High T4
Normal TSH

Question 13

What is the first line treatment for hyperthyroidism?

Answer 13

Carbimazole - taken for 12 to 18 months
Once the patient is euthyroid:
- Carbimazole is titrated OR
- A higher dose blocks all production, and levothyroxine is added and titrated

Question 14

What is the second line treatment for hyperthyroidism?

Answer 14

Propylthiouracil (due to hepatotoxicity)

Question 15

What is the treatment of hyperthyroidism during pregnancy?

Answer 15

Propylthiouracil is used in the first trimester, and then switched to carbimazole

Question 16

What is the first line treatment for severe Graves’ disease or toxic multinodular goitre?

Answer 16

Radioiodine treatment

Question 17

What is radioiodine treatment?

Answer 17

A single dose of radioactive iodine is drank
- The thyroid takes this up, and the emitted radiation destroys a proportion of the thyroid cells

Question 18

What are the strict rules of radioiodine treatment?

Answer 18

Women should not be pregnant, and should not conceive within 6 months of treatment
Men should not father treatment within 4 months of treatment
Limit contact with people after the dose

Question 19

What is De Quervian’s thyroiditis?

Answer 19

Temporary inflammation of the thyroid causes three phases:
- Thyrotoxicosis
- Hypothyroidism
- Return to normal

Question 20

What is the management of De Quervian’s thyroiditis?

Answer 20

NSAIDs
Beta blockers for symptoms of hyperthyroidism
Levothyroxine for symptoms of hypothyroidism

Question 21

What is the presentation of a thyroid storm?

Answer 21

Fever
Tachycardia
Delirium
Hypertension

Question 22

What is the management of a thyroid storm?

Answer 22

Beta blockers - IV propranolol
Anti-thyroid drugs - methimazole or propylthiouracil
Dexamethasone