Hyperthyroidism, Hypothyroidism/Thyroiditis 2 Flashcards
What are the symptoms of hyperthyroidism?
- Weight loss despite increased apetite
- Palpitations/ rapid pulse
- Sweating and heat intolerance
- Tiredness and weak muscles
- Nervousness, irritability and shakiness
- Mood swings or aggressive behaviour
- Frequent loos bowel movements
- Warm, moist hands
- Thirst
- Passing larger than usual amounts of urine
- Itchiness
- An enlarged thyroid gland (can be in hypo as well tho)
What are some of the classic eye features seen in hyperthyroidism ?
- Lid retraction
- Lid lag chemosis
- Proptosis
- Visual loss
- Diplopia
What is the thyroid antibody which is associated with hyperthyroidism mainly ?
TSH receptor antibody
What are the causes of hyperthyroidism ?
- Autoimmune graves disease (younger patients < 50)
- Nodular thyroid - Toxic multi-nodular goitre (think older patients > 50)
Thyroiditis (inflammation):
- Iodine - supplement, amiodarone, thyroxine
- Medications - lithium, amiodarone, thyroxine
How does graves disease cause hyperthyroidism?
It is an auto-immune disorder mediated by type II hypersensitivity reactions which result in Auto-antibodies binding to the TSHR stimulates the receptor à increased T3 and T4 secretion
What drug can cause both hypothyroidism and hyperthyroidism ?
Amiodarone
What is a thyroid storm ?
Severe hyperthyroidism. Emergency
What are the symptoms of a thyroid storm ?
- fever > 38.5ºC
- tachycardia
- confusion and agitation
- nausea and vomiting
- hypertension
- heart failure
- abnormal liver function test - jaundice may be seen clinically
What is the management of thyroid storm ?
- Lugols iodine
- Glucocorticoids - dexamethasone
- B-blockers - IV propanolol
- Anti-thyroid drugs - carbimazole (methimazole) or propothyouracil
- Fluid monitoring
What is the treatment of hyperthyroidism ?
- Carbimazole
- Propylthiouracil (if pregnant)
- B-blocker for rapid control of symptoms
50% of patients will relapse after oral treatment for hyperthyroidism - what can be done for those who relapse ?
- Radioiodine - tx of choice for toxic multi-nodular goitre
- Thyroidectomy
What does radioiodine therapy carry a big risk of ?
Causing the patient to develop hypothyroidism
What is thyroiditis ?
It is inflammation of the thyroid gland which can either cause high or low levels of thyroid hormone
What are the different types of thyroiditis ?
- Graves
- Hashimotos
- DeQuervians (sub-acute (viral))
- Post-partum (after pregnancy)
- Drug-induced - amiodarone, lithium
- Acute thyroiditis/supprative (bacterial)
Describe what sub-acute/ De-Quervians is ?
- May be triggered by viral infection
- May have associated sore throat and viral symptoms e.g. fever
- Usually causes hyperthyroidism + painful goitre + raised ESR in early stage. The may develop hypothyroidism in late stage
- Usually self-limiting - most dont need treatment
What are the thyroid hormone results of sub-acute thyroiditis/ De-Quervians?
- T4 high and TSH low in early stage
- T4 low and TSH high in late stage
- The results then normalise
Refer to case 7 slide 53 for example
