Thyroidism

Question 1

Interpreting TFT

Answer 1

HYPOTHYROIDISM = High TSH and Low T3/T4 or low free T4 
HYPERTHYROIDISM = Low TSH and High T3/T4 or High free T4

Question 2

Treatment Hyperthyroidism

Answer 2

1st Carbimazole usually for 12-18 mths
2nd Propylthiouracil if not okay on carbimazole
1mg Carbimazole = 10mg Propylthiouracil
Iodine also used as an antithyroid treatment before partial thyroidectomy.
Pregnancy:
Avoid carbimazole 1st trimester due to congenital defect, use propylthiouracil
Avoid Propylthiouracil 2nd trimester due to hepatotoxicity, use carbimazole

Question 3

Carbimazole counselling

Answer 3

REFER if sore throat, bruises, malaise, fever, non-spe illness develops - the risk of neutropenia and agranulocytosis (MHRA)
pancreatitis - discontinue indiffenetly (MHRA)