Hyperthyroidism Flashcards
What is hyperthyroidism?
The conditions caused by increased circulating free levels of thyroid hormones
Epidemiology of hyperthyroidism
2% prev.
1:5 male:female
Most common in middle age
Aetiology of hyperthyroidism
Most common: autoimmune thyroid disease i.e. graves
Toxic multinodular goitre
Toxic adenoma
Thyroiditis
What is Graves disease?
Accountable for 75% of all hyperthyroidisms
Autoimmune disorder to TSH by IgG = thyroid gland stimulation, increased T4 and thyroid growth
What is toxic multi nodular goitre?
Accounts for 15% of cases of hyperthyroidism
A long standing goitre may develop a hyperthyroidism. Surgery is required to fix it
What is a toxic adenoma?
Single nodule goitre which is hyper functioning and produces excess thyroid hormones + suppression of TSH
Rare causes of thyrotoxicosis
De Quervains (viral)
Amiodarone
Iodine excess
Symptoms of thyrotoxicosis
THYROIDISME
T = Tremor
H = Heart rate up
Y =Yawning [fatigability]
R = Restlessness
O = Oligomenorrhea & amenorrhea
I = Intolerance to heat,
D =Diarrhea
I = Irritability
S = Sweating
M = Musle wasting & weight loss
E = Exophthalmos
Signs in thyrotoxicosis
HANDS
- Fast/Irregular pulse
- Warm moist skin
- Tremor
- Palmar erythema
FACE
-Lid lag
-Lid retraction
Thin hair
NECK
-Goitre
Symptoms and signs specific to Graves disease
Mainly ophthalmoopathy
- exopthalmos
- opthalmoplegia
- eye discomfort and grittiness
- photophobia
- reduced acuity
Also pretibial myxoedema
Investigations to consider for thyrotoxicosis
TFTs: low TSH + increased free Ts Electrolytes: Increased Ca LFTs: Increased Thyroid antibodies Imaging: Increased in graves Ophthalmology
Management of thyrotoxicosis
Drug treatment is first line therapy with anti thyroid medication: carbimazole
Beta blockers to help with symptoms i.e. palpitations
Radiological: radio-iodine
Surgical: thyroidectomy
Treatment of thyroid associated opthalmopathy
Supportive + high dose steroids + immunosuppressants
Features of the thyroid storm
Severe symptoms of hyperthyroidism
-tachycardia + sweating + confusion
Mainly treated with high dose BB + immediate carbimazole + iodine + fluid
