Hyperthyroidism

Question 1

What is it?

Answer 1

Excess production of thyroid hormine T4/Thyroxine

Question 2

What is the main cause?

Answer 2

Grave’s Disease-an autoimmune condition in which circulating IgG autoantibodies bind to G protein Coupled Thyrotropin receptors and stimulate thyroid enlargement

Question 3

What else happens in graves disease?

Answer 3

The autoantibodies are also selective for orbital antigens so cause damage to the orbital socket and cause proptosis

Question 4

What other causes are there? (6)

Answer 4

Toxic multinodular goitre, Toxic Adenoma, Ectopic Thyroid Tissue, Exogenous e.g Iodine excess, Drugs (amiodarone, lithium), Post-partum

Question 5

Is it common?

Answer 5

Less common than hypo, 0.5% prevalence of grave’s

Question 6

Who does it affect?

Answer 6

Mainly women (9:1) aged 40-60 years old

Question 7

Symptoms (8)

Answer 7

Diarrhoea, weight loss, increased appetite, sweating, heat intolerance, palpitations, anxiety, oligomenorrhoea

Question 8

Signs (9)

Answer 8

Tremor, alopecia, arrhythmias, palmar erythema, lid lag, lid retraction, exopthalmos, pre-tibial myxoedema, brisk reflexes

Question 9

What blood tests would you do?

Answer 9

FBC, ESR, TFT, Ca, Thyroid Antibodies

Question 10

Other investigations (4)

Answer 10

Isotope scan, thyroid ultrasound, visual acuity, visual fields

Question 11

Drug Treatment (2)

Answer 11

Carbimazole, B-Blocker

Question 12

Other treatments

Answer 12

Radioiodine, thyroidectomy

Question 13

Are there any complications? (6)

Answer 13

Heart failure (Thyrotoxic Cardiomyopathy), Angina, AF, Osteoporosis, Opthalmopathy, Gynaecomastia