Hyperthyroidism

Question 1

Symptoms of Hyperthyroidism

Answer 1

Common

Increased appetite or normal

Weight loss

Warm skin/ heat intolerance - 7aaar

Sweating

Dyspnoea, fatigue

Mood- agitated irritable

Palpitations/ tremor

Others

Diarrhea

Menstruation: amenorrhea or oligomenorrhea

Exopthalmus (Grave’s disease)

Question 2

Signs of Hyperthyroidism

Answer 2

common

Fine tremor

Palmar erythema

Tachycardia

Lid retraction, Lid lag

Other

Goitre

Tachyponoea

Brisk reflexes

Question 3

Signs of graves’ disease

Answer 3

Eyes - exopthalmus, papilloedema, ophthalmopathy (swelling around eyes - lid lag)

Pretibial myxodema - orange peel on shins

Thyroidacropachy - soft tissue swelling of the hand and clubbing

Question 4

Investigating hyperthyroidism

Answer 4

TSH reduced

increased T3 and T4

Increased ESR

LFT increased

Thyroid autoantibodies

Optic nerve examination if eyes affected

Question 5

Causes of hyperthyroidism

Answer 5

Grave’s disease is the commonest cause

Toxic multinodular gitre

Toxic adenoma

De quervain’s thyroiditis

Question 6

Management of hyperthyroidism

Answer 6

Symptoms - Beta-blockers for tachycardia and eye drops for eye Sx

antithyoid drugs:
Carbmazole or Propylthiouracil

both of above interfere with synthesis of thyroid hormone

Radioiodine - high risk of hypothyroidism post-treatment

Thyroidectomy - risk of laryngeal nerve damage, hypoparathyroidism, hypothyroidism

Seek S/V if pregnant or infant

Question 7

Define thyrotoxicosis

Answer 7

it is the excess of circulating free T4 and free T3

Hyperthyroidism indicates thyroid gland over-activity resulting in thyrotoxicosis

Question 8

Tell me about AF and hyperthyroidism

Answer 8

It is present in 10% of all hyperthyroidism (in elderly mostly)

Thrombolise with warfarin

AF reverts to sinus rythm in 50% after euthyroid

Question 9

What is a thyroid storm

Answer 9

otherwise called thyrotoxic crisis

It is a medical emergency with a mortality of 10%

Prominenet signs: fever, agitation, confusion, tachycardia or AF, and cardiac failure

Precipated by infection in undiagnosed thyrotoxicosis
or
after subtotal thyroidectomy
or 
after radioiodine therapy

Question 10

Routes of carbimazole therapy

Answer 10

Orally

if unconscious rectally