Thyroid_Hyperthyroidism Flashcards
Causes of hyperthyroidism
Grave’s Disease
Goitre: Toxic mutinodular goitre
Toxic Adenoma
Thyroiditis (postpartum, drug induced, subacute) –>
- Risk factors for Grave’s Disease
- Diagnosis of Grave’s disease
- What % of patients with grave’s do not have Thyroid Receptor Ab’s +ve?
- Is an U/S req’d?
- Stress, Smoking, Female gender, family history, postpartum
- Symptoms (e.g Symmetrical goitre, opthalmopathy, skin changes) / low TSH/ high T4/ Thyroid Receptor Ab’s
- 10%
- Not routinely (doesn’t differentiate between graves and thyroiditis)
What is the course of disease in thyroiditis?
Characteristically has a triphasic course of hyperthyroidism followed by hypothyroidism, resolving to euthyroidism (mja article)
Usually no treatment req’d during thyrotoxic phase
Repeat TSH 6-8weekly till resolution, if hypothyroid –. Replace
(Ref: MJA article)
1/ Management of Grave’s?
2/ How long to treat for?
Symptomatic:
- Beta Blocker for heart rate
Carmbimazole 10-45mg/day in 2-3 divided doses (AMH)
Propylthiouracil 200–400 mg daily in 2–4 doses for 3–4 weeks.
2/ For 12-18 months
Can cease if pt euthyroid on a low dose.
TFt’s 4/52 after commencement.
Till pt euthyroid repeat levels every 4-8/52
(ref AMH)
(ref: blood disorders Check)
What are the Opthamological features of grave’s?
lid lag, periorbital oedema,
Carbimazole
- side effects common
- rare but life threatening complications
- What are the features of this complication?
- itching, rash, nausea, vomiting, GI upset, headache
- agranulocytosis
- Tell your doctor immediately if you develop a fever, mouth ulcers, sore throat, rash, severe fatigue, nausea, abdominal pain or jaundice
(ref AMH)
Which medication is preferred in pregnancy in first trimester?
Propylthiouracil
Investigations
TSH receptor Ab’s
TFT’s
Radionucleotide scan
What is the risk of thromboembolism in atrial flutter/fibrillation?
There maybe an increased risk
ref: blood disorders Check
