Hyperthyroidism

Question 1

Hyperthyroidism symptoms?

Answer 1

Heat intolerance/sweating
Palpitations/irregular pulse
Irritability
Weight loss despite good appetite
Diarrhoea
Oligomenorrhoea/amenorrhoea (females)
Impotence (males)
Tremor

Question 2

TFT results in hyperthyroidism?

Answer 2

Reduced TSH

Increased T3/4

Question 3

Pathophysiology of hyperthyroidism + 2 types of causes?

Answer 3

Excess circulating T3/T4 due to:

• increased thyroid hormone synthesis (hyperthyroidism)
• increased release of thyroid hormone stores (thyroiditis)

Question 4

Causes of hyperthyroidism?

Answer 4

Graves’ disease
De Quervain’s thyroiditis
Toxic multinodular goitre
Adenoma

Question 5

Graves’ disease triad?

Answer 5

Exophthalmos
Pretibial myxoedema
Thyroid acropachy (clubbing, finger/toe soft tissue swelling, periosteal new bone formation) (may mention in the exam as just acropachy or the signs)

Question 6

Features of Graves’ disease (pathophysiology + associations)?

Answer 6

Autoantibodies to TSH receptor (bind and stimulate thyroid to produce T3/4)

Associated with other autoimmune diseases e.g. Addison’s, vitiligo, T1DM

Question 7

When/how does De Quervain’s thyroiditis present? (signs/symptoms/test results)

Answer 7

Post-viral infection

Presents with

• fever
• painful goitre

Test results include a high ESR

Question 8

Treatment of De Quervain’s thyroiditis?

Answer 8

NSAIDs

Question 9

In who/where does toxic multinodular goitre occur?

Answer 9

Elderly people

Iodine deficient areas

Question 10

What is a hyperthyroiditic adenoma?

Answer 10

Solitary nodule producing T3/T4

Question 11

Radioisotope scan findings for each cause of hyperthyroidism?

Answer 11

Graves’ = diffuse increased uptake (smooth diffuse goitre)

De Quervain’s thyroiditis - NO uptake (stores being released = cause of hyperthyroidism, not excess production)

Toxic multinodular goitre - multiple areas of increased uptake

Adenoma - single area of increased uptake