Thyrotoxicosis Flashcards
What is thyrotoxicosis?
clinical effect of excess thyroid hormone, usually from gland hyperfunction
What are causes of hyperthyroidism?
- Grave’s disease
- Toxic multinodual goitre
- Toxic adenoma
- Ectopic thyroid tissue
- Exogenous
- Subacute de Quer Thyroidisitis
- Drugs
- Post-partum
- TB
How common is Grave’s?
- 2/3 of hyperthyroidism
- Men to women 9:1
- 40-60yrs
- Lots T3
- Autoimmune
When does toxic multinodular goitre happen? What is treatment?
- elderly and iodine deficient
2. surgery for decompression indicted if symptoms (dysphagia, dyspnoea)
What is ectopic thyroid tissue?
metastatic follicular thyroid cancer
What are exogenous causes of hyperthyroidism?
- iodine excess
2. levothyroixine excess
What are the SDQ thyroiditis symptoms?
- goitre
- High Temp
- High ESR
What drugs can cause thyrotoxicosis?
- Amiodarone
2. lithium
What are symptoms of thyrotoxicosis?
- Diarrhoea
- Loss of weight
- Increased appetite
- Over-active
- Sweats
- Irritability
What are signs of thyrotoxicosis?
- Pulse fast (AF, ST)
- Warm, moist skin
- Fine tremor
- Palmar erythema
- Goitre
- Thyroid nodules
What are signs of Grave’s disease?
- Eye disease (exopthalamos, ophthalamoplegia)
- Pretibial myoexdema (oedematous selling above lateral malleoli
- Thyroid acropachy
What may investigations show in thyrotoxicosis?
- TSH: low
- T3 and T4: high
- Mild normocytic anaemia
- Mild neutropenia (in Graves)
- High ESR
- High Ca2+
- High LFTs
- Check thyroid autoantibodies
What is treatment for thyrotoxicosis?
- Beta blockers: e.g. propranolol 40mg/6h
- Carbimazole
- Radioiodine
- Thyroidectomy
What are side effects of carbimazole?
agranulocytosis so low neutrophils
What are the possible complications of thyrotoxicosis?
- Heart failure (thyrotoxic myopathy)
- Angina
- AF
- Thyroid Storm
- Osteoporosis
- Opthalmopathy
- Gynaecomastia
What are 2 mechanisms that might cause you to have hyperthyroidism (excess ciruclating T3/T4)?
- Increase in thyroid hormone synthesis: hyperthyroidism
2. Increased released of stores thyroid hormones: thyroiditis
What is the mechanism of Grave’s disease?
- Autoantibtidies to TSH receptor
- Associated with other AI disease
- Grave’s triad: expothlamos, pretibial myxedema and thyroid acropachy
What does De Quervain’s present with and how is it treated?
- Post-viral
- Fever
- High ESR
- Causes PAINFUL goitre
- Self-limiting (treat with NSAIDs)
When do you see toxic multinodular goitre?
- elderly
2. iodine deficient areas
What is an adenoma?
solitary nodule producing T3/T4
How does Grave’s disease show on a radioisotope scan?
diffuse increased uptake (smooth diffuse goitre)
How does thyroiditis show on radioiodine uptake scan?
No uptake
How does toxic multinodular goitre show up on radiosotope scan?
multiple areas of increased uptake
How does adenoma show on radisotope scan show?
single area of increased uptake
