Thyrotoxicosis Flashcards
Causes
Grave’s disease
Toxic nodular goitre
Acute phase of subacute thyroiditis
Acute phase of post-partum thyroiditis
Acute phase of Hashimoto’s thyroiditis
Amiodarone therapy
Contrast
Universal features of hyperthyroidism
Anxiety and irritability
Sweating and heat intolerance
Tachycardia and palpitations
Weight loss
Fatigue
Frequent loose stools
Sexual dysfunction
Oligomenorrhoea
Grave’s disease
Autoimmune
TSH receptor antibodies are abnormal antibodies that mimic TSH
Most common cause of thyrotoxicosis
Toxic multinodular goitre
Plummer’s disease
Nodules act independently of normal feedback system
Unique features of Grave’s disease
Diffuse goitre (without nodules)
Graves eye disease
Bilateral exopthalmos
Pretibial myxoedema
Unique features of toxic multinodular goitre
Goitre with firm nodules
Most patients over 50
Second most common cause of thyrotoxicosis
Solitary toxic thyroid nodule
Single abnormal thyroid nodule acting alone to release thyroid hormone
Usually benign adenomas
Treated with surgical removal
De Quervain’s thyroiditis
Presentation of viral infection with fever, neck pain and tenderness, dysphagia and hyperthyroidism
Hyperthyroid phase followed by hypothyroid phase as TSH falls due to negative feedback
Self-limiting condition
Supportive treatment with NSAIDs for pain/inflammation and beta-blockers for hyperthyroid symptoms
Thyroid storm
More severe presentation of hyperthyroidism with pyrexia, tachycardia and delirium
Requires admission for monitoring
May need fluid resuscitation, anti-arrhythmic medication and beta-blockers
First line management
Carbimazole 40mg and reduced gradually to maintain euthyroidism
Typically 12-18months
Carbimazole complication
Agranulocytosis
Radioactive iodine
Drink single dose of iodine and taken up by thyroid gland
Emitted radiation destroys proportion of thyroid cells
Reduction in functioning decreases thyroid hormone production
Remission can take 6 months
Rules for radioactive iodine
Must not be pregnant/ can’t get pregnant within 6 months
Avoid close contact with children and pregnant women for 3 weeks
Limit contact with anyone for several days after dose
Beta blockers
Used to block adrenaline related symptoms
Propanolol non-selectively blocks adrenergic activity
Particularly useful for patients with thyroid storm