Hyperthyroidism Flashcards
What is thyrotoxicosis?
Abnormal and excessive quantity of thyroid hormomes (due to any cause)
What is subclinical hyperthyroidism?
T3 and T4 levels are normal, but TSH is suppressed
What is the most common cause of primary hyperthyroidism?
Graves’ disease
What are the causes of hyperthyroidism?
GIST
G - graves’ disease
I - inflammation
S - solitary toxic thyroid nodule
T - toxic multinodular goitre
What clinical picture does thyroiditis often present with?
Causes an initial period of hyperthyroidism, followed by under-activity of the thyroid gland
What are the causes of thyroiditis?
De Quervian’s thyroiditis
Hashimoto’s thyroiditis
Postpartum thyroiditis
Drug-induced thyroiditis
What is the presentation of hyperthyroidism?
Anxiety and irritability
Sweating and heat intolerance
Tachycardia
Weight loss
Fatigue
Insomnia
Frequent loose stools
Sexual dysfunction
Menstrual irregularity
What are the signs specific to Graves’ disease?
Diffuse goitre
Graves’ eye disease including exophthalmos
Pretibilar myxoedema
Thyroid acropachy
What investigations are used in the diagnosis of hyperthyroidism?
TFTs - first line
Antibodies - anti-TSH receptor positive in patients with Graves’ disease
Thyroid ultrasound
Technetium radionuclide scan
ECG - AF
What TFT results will be seen in primary hyperthyroidism?
High T4
Low TSH
What TFT results will be seen in subclinical hyperthyroidism?
Normal T4
Low TSH
What TFT results will be seen in secondary hyperthyroidism?
High T4
Normal TSH
What is the first line treatment for hyperthyroidism?
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
What is the second line treatment for hyperthyroidism?
Propylthiouracil (due to hepatotoxicity)
What is the treatment of hyperthyroidism during pregnancy?
Propylthiouracil is used in the first trimester, and then switched to carbimazole
What is the first line treatment for severe Graves’ disease or toxic multinodular goitre?
Radioiodine treatment
What is radioiodine treatment?
A single dose of radioactive iodine is drank
- The thyroid takes this up, and the emitted radiation destroys a proportion of the thyroid cells
What are the strict rules of radioiodine treatment?
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
What is De Quervian’s thyroiditis?
Temporary inflammation of the thyroid causes three phases:
- Thyrotoxicosis
- Hypothyroidism
- Return to normal
What is the management of De Quervian’s thyroiditis?
NSAIDs
Beta blockers for symptoms of hyperthyroidism
Levothyroxine for symptoms of hypothyroidism
What is the presentation of a thyroid storm?
Fever
Tachycardia
Delirium
Hypertension
What is the management of a thyroid storm?
Beta blockers - IV propranolol
Anti-thyroid drugs - methimazole or propylthiouracil
Dexamethasone