Hyperthyroidism Flashcards
What are the symptoms of Hyperthyroidism?
Heat intolerance Wt loss Increased appetite Diarrhoea Palpitations Tremor Irritability Oligomenorrhoea/Infertility
What are the signs of Hyperthyroidism?
Thin hair Fast pulse Fine tremor Hyper reflexive May have goitre
What are the signs of Graves’ disease?
Exopthalmos due to cross reactivity of TSH antibodies with peri orbital fat causing inflammation.
Opthalmoplegia
Eye discomfort/Grittiness
What investigations can be done for a patient with suspected Hyperthyroidism?
↓TSH
↑T4/↑T3
TSH receptor antibodies
Increase isotope uptake in thyroid
What can trigger Graves’ disease?
Childbirth
Stress/Infection
What are the causes of Hyperthyroidism?
Graves’ disease (F>M, 40-60 y/o)
Toxic adenoma - hot nodule in thyroid that takes up iodine, may produce T3/T4
Thyroxine - overtreatment of Hypothyroidism
Antibodies attack and stimulate thyroid
What is the management of Hyperthyroidism?
Symptomatic - B blockers propanolol 40mg
Anti thyroid - Carbimazole (inhibits TPO = Thyroid peroxidase)
Radioactive iodine - may become hypo due to destruction. Contraindicated in pregnancy or mothers lactating
Tyroidectomy
What is the side effect of Carbimazole?
Agranulocytosis (deficiency of granulocytes in the blood, causing increased vulnerability to infection)
What are the complications of a Thyroidectomy?
Recurrent laryngeal nerve palsy = hoarse voice
Hypothyroidism
Hypoparathyroidism
What are the features of a Thyroid storm?
↑ temp Agitation, confusion, coma Tachycardia, AF Acute abdomen Heart failure
What can precipitate a Thyroid storm?
Recent thyroid surgery or radio-iodine
Infection
MI
Trauma
What is the management of a Thyroid storm?
- Fluid resuscitation + NG Tube
- Bloods: TFTs + cultures if infection suspected
- Propranolol PO/IV
- Digoxin may be needed
- Carbimazole
- Hydrocortisone
- Treat cause
