Thyrotoxicosis

Question 1

What is thyrotoxicosis?

Answer 1

clinical effect of excess thyroid hormone, usually from gland hyperfunction

Question 2

What are causes of hyperthyroidism?

Answer 2

1. Grave’s disease
2. Toxic multinodual goitre
3. Toxic adenoma
4. Ectopic thyroid tissue
5. Exogenous
6. Subacute de Quer Thyroidisitis
7. Drugs
8. Post-partum
9. TB

Question 3

How common is Grave’s?

Answer 3

1. 2/3 of hyperthyroidism
2. Men to women 9:1
3. 40-60yrs
4. Lots T3
5. Autoimmune

Question 4

When does toxic multinodular goitre happen? What is treatment?

Answer 4

1. elderly and iodine deficient

2. surgery for decompression indicted if symptoms (dysphagia, dyspnoea)

Question 5

What is ectopic thyroid tissue?

Answer 5

metastatic follicular thyroid cancer

Question 6

What are exogenous causes of hyperthyroidism?

Answer 6

1. iodine excess

2. levothyroixine excess

Question 7

What are the SDQ thyroiditis symptoms?

Answer 7

1. goitre
2. High Temp
3. High ESR

Question 8

What drugs can cause thyrotoxicosis?

Answer 8

1. Amiodarone

2. lithium

Question 9

What are symptoms of thyrotoxicosis?

Answer 9

1. Diarrhoea
2. Loss of weight
3. Increased appetite
4. Over-active
5. Sweats
6. Irritability

Question 10

What are signs of thyrotoxicosis?

Answer 10

1. Pulse fast (AF, ST)
2. Warm, moist skin
3. Fine tremor
4. Palmar erythema
5. Goitre
6. Thyroid nodules

Question 11

What are signs of Grave’s disease?

Answer 11

1. Eye disease (exopthalamos, ophthalamoplegia)
2. Pretibial myoexdema (oedematous selling above lateral malleoli
3. Thyroid acropachy

Question 12

What may investigations show in thyrotoxicosis?

Answer 12

1. TSH: low
2. T3 and T4: high
3. Mild normocytic anaemia
4. Mild neutropenia (in Graves)
5. High ESR
6. High Ca2+
7. High LFTs
8. Check thyroid autoantibodies

Question 13

What is treatment for thyrotoxicosis?

Answer 13

1. Beta blockers: e.g. propranolol 40mg/6h
2. Carbimazole
3. Radioiodine
4. Thyroidectomy

Question 14

What are side effects of carbimazole?

Answer 14

agranulocytosis so low neutrophils

Question 15

What are the possible complications of thyrotoxicosis?

Answer 15

1. Heart failure (thyrotoxic myopathy)
2. Angina
3. AF
4. Thyroid Storm
5. Osteoporosis
6. Opthalmopathy
7. Gynaecomastia

Question 16

What are 2 mechanisms that might cause you to have hyperthyroidism (excess ciruclating T3/T4)?

Answer 16

1. Increase in thyroid hormone synthesis: hyperthyroidism

2. Increased released of stores thyroid hormones: thyroiditis

Question 17

What is the mechanism of Grave’s disease?

Answer 17

1. Autoantibtidies to TSH receptor
2. Associated with other AI disease
3. Grave’s triad: expothlamos, pretibial myxedema and thyroid acropachy

Question 18

What does De Quervain’s present with and how is it treated?

Answer 18

1. Post-viral
2. Fever
3. High ESR
4. Causes PAINFUL goitre
5. Self-limiting (treat with NSAIDs)

Question 19

When do you see toxic multinodular goitre?

Answer 19

1. elderly

2. iodine deficient areas

Question 20

What is an adenoma?

Answer 20

solitary nodule producing T3/T4

Question 21

How does Grave’s disease show on a radioisotope scan?

Answer 21

diffuse increased uptake (smooth diffuse goitre)

Question 22

How does thyroiditis show on radioiodine uptake scan?

Answer 22

No uptake

Question 23

How does toxic multinodular goitre show up on radiosotope scan?

Answer 23

multiple areas of increased uptake

Question 24

How does adenoma show on radisotope scan show?

Answer 24

single area of increased uptake