thyroid - overactive Flashcards
bloods for subclinical hyperthyroid
normal free T3/4 // TSH < 0.1
causes of subclinical hyperthyroid
multinodular goitre - esp elderly females
complications subclinical hyperthyroid
AF, osteoporosis, dementia
mx subclinical hyperthyroid
observe // trial low-dose Anti-thyroid for 6 months
bloods in primary hyperthyroid
low TSH // high free T4
bloods in secondary hyperthyroid
high TSH // high free T4
general + GI + neuro symptoms hyperthyroid (7)
weight loss // restlessness // too hot // anxiety // tremor // diarrhoea
cardio, skin, gynae, symptoms hyperthyroid
palpitations, tachycardia // high CO failure // sweating // pretibial myoxedema // clubbing // oligomenorrhoa
what is pretibial myxoedema
red, oedema on lateral malleolus
eye symptoms hyperthyroid
expothalamus (bulging) // conjunctival oedema // papilloedema // opthamloplegia // can’t close eyes
RF developing thyroid eye disease
smoking // radioiodine
what is deposited in the eye muscles in graves
glycosaminoglycan + collagen
mx thyroid eye disease
lubricants // steroids // radio // surgery
who should mx thyroid eye disease
deterioration of vision –> urgent optho
causes thyrotoxicosis
graves // toxic nodular goitre // acute de Quervains or post-partum // amiodarone // contrast
invx hyperthyroid
TSH // antibodies // iodine isotope scan
most common cause hyperthyroid
graves
who usually gets graves
women 30-50
symptoms Graves
expothalamus, opththalmoplegia // pretibial myxoedema // thyroid acropachy - clubbing, soft tissue swelling, periosteal bone
antibodies in graves
TSH (90%) TPO (75%)
what is seen on thyroid scintigraphy of graves
diffuse, homogenous, increase uptake of radioactive iodine
initial mx graves
propanolol to control symptoms
who manages graves patients and what mx can be started in primary care
refer to endocrinologist (carbimazole can be given by GP if not controlled with propanolol)
1st line ATD for hyperthyroid
carbimazole 40mg and reduce gradually for 12-18 months
what drug is added in hyperthyroid when euthyroidism is met
thyroxine
SE carbimazole
agranulocytosis // crosses placenta
2nd line ATD hyperthyroid
Propylthiouracil
when is radioiodine used in graves
relapse following ATD/ resistant
contraindications radioiodine
pregnancy // <16 // (thyroid eye dease relative)
SE radioiodine
hypothyroid
what is toxic multinodular goitre cause
multiple thyroid nodules –> hyperthyroid
nuclear scintigraphy toxic multinodular goitre
patchy uptake
mx toxic multinodular goitre
radioiodine therapy
what can cause thyroid storm
thyroid surgery // trauma // infection // iodine load eg CT contrast
symptoms thyroid storm
fever >38.5 // raised HR // confusion + agitation // N+V // raised BP // HF // jaundice + LFTs
mx thyroid storm (4)
IV propranolol // ATD eg methimazole or propylthiouracil // Lugols iodine // dexamethasone
what causes subacute De Quervains thyroiditis
viral infection
phases DeQuarvains thyroiditis
1 = 3-6 weeks of hyperthyroid, painful goitre // 2 = euthyroid // 3 = weeks - months hypothyroid
what blood is raised in phase 1 subacute thyroiditis
ESR
invx subacute thyroiditis
thyroid scintigraphy - reduced uptake of iodine 131
mx subacute thyroiditis
self limitn // aspirin, NSAIDs, steroids
