Thyroid disorders

Question 1

What is are the different methods used to achieve euthyroidism in hyperthyroidism?

Answer 1

Thionamides (anti-thyroid drugs) e.g carbimazole
Radioactive Iodine
Thyroidectomy

Question 2

Which medication can be used for symptomatic relief of hyperthyroidism?

Answer 2

Beta Blockers:

Provides relief for the:
Tremor
Tachycardia
Anxiety

Question 3

Describe the mechanism of action of thionamides and any adverse effects?

Answer 3

They inhibit thyroid peroxidase stopping the iodination of throglobulin therefore decreasing the synthesis of thryoid hormones.

Takes several weeks to take affect as the tyroid hormones have long half lives.

May cause agranulocytosis leading to leucopenia.	
If patients reports:
-sore throats
-mouth ulcers
-bruising or non-specific illness

Do a FBC to look for leucopenia and discontinue if it is present.

Question 4

Describe the rough treatment regimen of pharmaceutically managed hyperthyroidism?

Answer 4

High dose carbimazole for 1-2 months to induce remission then a maintenance dose being gradually reduced over 18 months.

Treat symptoms with beta blockers.

If the carbimazole induces hypothyroidism add in thyroxine also.

Question 5

Describe the treatment of hypothyroidism?

Answer 5

Replacement therapy with levothyroxine.

Dose is the amount required to achieve normal thyroid function.

Note: start on a lower dose in the elderly as it can worsen or uncover angina.