Thyrotoxicosis Flashcards
Cardiac signs of thyrotoxicosis (2)
AF/SVT
Eye signs (not graves specific) (2)
Lid lag Lid retraction (lid above sclera
Graves’ signs (3)
Eye disease (2)
Pretibial myxoedema
Thyroid acropachy
Graves’ related eye dieases (2)
Exophthalmos
Opthalmoplegia
Pretibial myxoedema location and description
Oedematous swelling above lateral malleolus
Graves M>F? T or F
false - 9:1 F:M
Pathogenesis of graves
IgG autoantibodies
bind thyrotropin-R
Increase T3 and smooth thyroid enlargment
react with orbital antigens
Iodine-deficiency causes
Toxic multinodular goitre (surgery indicated for compressive symptoms - dysphagia)
Toxic adenoma
Solitary nodule producing t3/t4
Exogenous causes
Iodine intake excess, levothyroxine (^t4 not t3)
De Quervains thyroiditis is seen when with what goitre
Post-viral
Painful goitre
(it is self-limiting)
Drugs that cause thyroiditis (2)
Amiodarone
Lithium
How to control symptoms
PROPRANOLOL
B-adrenergic tone is up
What are the 2 approaches for anti thyroid medication
Titration
Block and replace
Explain block and replace
CARBIMAZOLE + THYROXINE silmultaneously
decrease risk of iatrogenic hypothyroidism
Explain titration treatment
CARBIMAZOLE for 4 weeks, reduce according to TFTs every 1-2 months
Explain the treatment journey in Graves
Tx for c.18 months, 50% relapse. Then require surgery/radioiodine
SE of carbimazole
agranulcytosis (0.03% –> dangerous sepsis. warn to stop and seek FBC/medical help if ulcer/infections)
Risk of throidectomy
Recurrent laryngeal nerve damage (hoarse voice)
CI for I131
Pregnant
Lactating
Main risk factor for thyroid eye disease
smoking (stop!)
Tx of severe ophthalmoplegia
IV METHYPREDNISOLONE
All goitre is diffuse except (3)
Multinodular
Adenoma
Carcinoma