Hyperthyroidism

Question 1

What is hyperthyroidism?

Answer 1

The clinical effects of excess thyroid hormone.

Question 2

What is thyrotoxicosis?

Answer 2

Thyrotoxicosis is the syndrome resulting from excess thyroid hormones (can occur without hyperthyroidism)

Question 3

What are signs of hyperthyroidism?

Answer 3

• Fast/irregular pulse
	• Warm, moist skin
	• Fine tremor
	• Goitre 
Lid lag, lid retraction

Question 4

What are Grave’s specific signs of hyperthyroidism>

Answer 4

• Eye discomfort 
	• Grittiness 
	• Diplopia 
	• Decreased acuity 
	• Exophthalmos
	• Proptosis 
Conjunctival oedema

Pretibial myxoedema

GRave’s acropachy

Question 5

What are causes of primary hyperthyroidism?

Answer 5

Graves: autoimmune disease caused by IgG autoantibodies binding to G-coupled TSH receptors on cell surface

toxic multinodular goitre

toxic adenoma

ectopic thyroid tissue e.g. met thyroid cancer

too much levothyroxine and iodine excess

De Quervian’s thyroiditis: viral cause, painful goitre.

amiodarone

Question 6

What is the difference between 2 types of hyperthyroidism caused by amidarone?

Answer 6

• Type 1: autoimmune thyrotoxicosis. Treat with high dose carbimazole
Type 2: destructive thyroiditis. Treat with glucocorticoids.

Question 7

What are causes of secondary hyperthyroidism>

Answer 7

increased TSH, increased T4/T3
	• Very rare
	• TSHoma or TRHoma 
	• Thyroid resistance syndrome
Gestational: HCG has homology with TSH receptor

Question 8

What Ix in hyperthyroidism>

Answer 8

Raised T4/T3, low TSH (primary) or normal/high (pituitary)

Autoantibodies: TSH receptors, TPO, Antithyroglobulin

US: benign or malignancy goitre?

Radio-isotope imaging: hot and cold nodules

Ophthalmology: eye tests if graves is suspected

Question 9

What is Rx of hyperthyroidism>

Answer 9

BB: Rapid control of symptoms whilst anti-thyroid drugs become effect
e.g. propranolol

Carbimazole: inhibit TPO +/- levothyroxine to decrease risk of hypo (block and replace)

Propylthiurcal in pregnancy

Radioiodine

Thyroidectomy: large goitre, cant give radioiodine.

Question 10

What are SE of thyroidectomy?

Answer 10

Hypoparathyoidism
hypothyroidism
recurrently laryngeal nerve palsy

Question 11

What are complications of hyperthyroidism?

Answer 11

• Thyroid storm
• Heart failure
• Angina
AF