Thyrotoxicosis Flashcards
What would a patient with thyrotoxicosis present with
weight loss
restlessness
heat intolerance
palpitations, tachycardia
high-output cardiac failure in elderly
increased sweating
diarrhoea
oligomenorrhoea
anxiety and tremor
What are causes if thyrotoxicosis
Graves disease
toxic nodular goitre-
( Plummers disease) autonomously functioning thyroid nodules resulting in hyperthyroidism
de Quervains thyroiditis-
following viral infection
phase 1
acute phase of post partum thyroiditis
amiodarone therapy
contrast
What are some signs that would only be seen in Graves disease
exopthalmos
opthalmoplegia
pretibial myxoedma
smooth large goitre
reddening/thickening of skin
digital clubbing
What are some investigation for thyrotoxicosis
Thyroid function
- low TSH, high T3 and high T4
Thyroid autoantibodies for Graves
-TSH receptor stimulating antibodies
-Anti TPO antibodies
What would be seen on a thyroid scintigraphy/iodine scan in Graves disease
diffuse increased uptake
What would be seen on a thyroid scintigraphy /iodine scan in toxic multinodular goitre
multiple hot nodules
What would be seen on thyroid scintigraphy/iodine scan in De quervains thyroiditis
globally reduced uptake
What are some causes of thyroiditis
De Quervain’s thyroiditis
Hashimoto’s thyroiditis
postpartum thyroiditis
drug-induced thyroiditis
What is the management for graves disease
propranolol - for symptoms such as tachycardia/palpitations
Anti-thyroid therapy
first line Carbimazole 40mg , reduce gradually
Radioiodine treatment if relapse/resistant to anti-thyroid therapy
What is the main complication of carbimazole therapy
agranulocytosis
leads to increased vulnerability to infection
How is carbimazole given to patients
either at 40mg then gradually reduced to maintain euthyroidism
for 12-18 months
( ATD titration regime ) - fewer side effects
OR
‘block and replace’
- carbimazole started at 40mg
thyroxine added when patient is euthyroid
treatment for 6-9 months
What is the second line anti-thyroid drug
Propylthiouracil
small risk of severe liver reaction
When is radioiodine used as a treatment for graves
often used in patients who relapse following ATD therapy or are resistant
What are some contraindications for using radioiodine in graves
pregnnacy
age <16 years
thyroid eye disease
What will most patients need after radioiodine treatment
thyroxine supplementation after 5 years
How do you treat De Quervains thyroiditis
self-limiting
-aspirin for pain
How do you treat toxic multinodular goitre
radioiodine therapy
What is a thyroid storm
rare life threatening complication of thyrotoxicosis
What are some precipitating events for a thyroid storm
thyroid/non-thyroidal surgery
trauma
infection
acute iodine load
What are some clinical features of a thyroid storm
fever >38.5
tachycardia
confusion and agitation
nausea and vomiting
hypertension
heart failure
may see jaundice
What is the management of a thyroid storm
symptomatic relief
treat underlying precipitating event
beta blockers- IV propranolol
anti-thyroid drugs– PTU
Lugol’s iodine
Dexamethasone - blocks conversion of T4 to T3
What would the nuclear scintigraphy for toxic multinodular goitre show
patchy uptake
multiple ill defined foci of uptake
irregular dispersal of hot and cold areas
