Thyroid Flashcards
What is the treatment pathway in managing a patient who is iatrogenically hyperthyroid? (i.e. after treating their hypothyroidism)
Reduce their thyroxine by 25mg.
Check when they take their thyroxine (e.g. milk affects absorption, should be taken 30 minutes before breakfast)
Check their diet for excessive iodine content and things that affect thyroxine uptake.
Monitor for 3-6 months.
What is the treatment pathway for hypothyroidism?
Different if the patient presents with hypothyroid coma
- Levothyroxine 50-150 micrograms PO OD
- Review every 3-4 weeks to titrations
CI for treatment:
- Suspected adrenal failure (can precipitate adrenal crisis)
- Neck lump (requires referral to endocrine or 2WW pathway)
- Preexisting cardiac disease (risk of tachycardia etc)
What is the treatment pathway for hypothyroid coma?
If in hypothyroid coma (aka myxoedema coma):
- Emergency admission to hospital
- IV Levothyroxine
- IV Hydrocortisone
(Myxoedema coma is the extreme of all the signs of hypothyroidism)
What is the treatment pathway for hyperthyroidism?
A different pathway exists for thyroid storm
- Beta blockers (Adrenergic symptom relief)
- Carbimazole or propylthiouracil for 6-24 months (euthyroid in 1-2 months)
Regimes: titration of dose, or block and replace (Levothyroxine added in when needed)
If hyperthyroidism is severe or resistant/intolerant to pharmacological treatment:
- 131-Radioiodine treatment:
- 4 weeks no contact with other people
- CI: Graves’ disease - Thyroidectomy
Indications:
- Severe hypothyroidism
-Large goitre causing compression symptoms (dysphagia)
What are the risks of total thyroidectomy?
all patients become hypothyroid
parathyroid damage
vocal cord paralysis
bleeding
How do you treat papillary carcinoma?
- Thyroidectomy or lobectomy if needle biopsy grading is THY 3,4 or 5
- 131 RadioIodine treatment
- TSH suppression with Levothyroxine (TSH is a stimulating factor for papillary carcinoma growth)
