Hyperthyroidism

Question 1

Define thyrotoxicosis

Answer 1

Clinical effect of excess thyroid hormone, usually from gland hyperfunction

Question 2

Outline the symptoms & signs of hyperthyroidism

Answer 2

Symptoms & signs THYROIDISM

• Tremor
• Heart - rate fast & irregular, palpitations
• Your neck’s fat..
• Restlessness
• Oligomenorrhoea +/- infertility
• Irritable
• Diarrhoea, weight loss
• I’s – lid lad & retraction
• Sweating, heart intolerance
• Moist skin

Question 3

What are the specific signs of graves disease?

Answer 3

1. Eye disease
   
   • exophthalmos (eye protrusion)
   • opthalmoplegia (eye muscle paralysis)
2. Pretibial myxoedema
   
   • oedema above lateral malleolus (ankle oedema)
3. Thyroid acropachy
   
   • clubbing, painful finger & periosteal reaction in limb bones

Question 4

Outline the investigations for hyperthyroidism

Answer 4

• Low TSH (suppressed) & High T3 & T4
• Thyroid autoantibodies?
• If opthalmopathy - check visual fields

Question 5

Outline the causes of hyperthyroidism

Answer 5

• Graves disease
  
  • Circulating IgG antibodies ⇒ thyrotropin ⇒ thyroid enlargement & inc T3/T4
  • Middle-aged females
• Toxic multinodular goitre
  
  • Nodules secrete thyroid hormone
  • Elderly & iodine deficient
• Toxic adenoma
  
  • Solitary nodule producing T3/ T4
  • Isotope scan shows hot nodule
• Ectopic thyroid disease
  
  • Metastatic folliculr thyroid cancer or struma ovarri
• Exogenous
  
  • Iodine excess

Question 6

How would you treat thyrotoxicosis?

Answer 6

1. Carbimazole - anti-thyroid
2. Radioiodine¹³¹
3. Thyroidectomy - risk to laryngeal nerve (hoarse voice) & hypoparathyroidism