Hyperthyroidism

Question 1

etiology

Answer 1

• Graves disease

- thyroiditis, toxic adenoma, toxic multinodular goitre

Question 2

Labs

Answer 2

TSH (low), order T3 and fT4
-graves? thyroid receptor antibodies (TSII TBII)

Radioactive iodine uptake and scan

Question 3

radioactive iodine uptake scan and interpretation

[diffuse, multiple foci, one focus]

Answer 3

high uptake:

• diffuse: grave’s disease
• multiple foci: toxic multinodular adenoma
• one focus: toxic adenoma

Low uptake:

• subacute thyoriditis
• exogenous hormone

Question 4

treatment

Answer 4

all hyperthyroid REFER to endocrinology

Graves: thionamides
-if opthalmopathy, glucocorticoids vs. surgery

acute Mx
-propranalol + methimazole (baseline CBC and LFTs)

Question 5

treatment approach to subclinical

Answer 5

risk stratify
-high risk: postmenopausal women, elderly, pt’s w/ CV disease

TSH <0.1? high risk Tx; low risk consider Tx
TSH 0.1-0.5 high risk consider Tx; low risk observe