Thyrotoxicosis Flashcards

1
Q

What are symptoms of thyrotoxicosis?

A
Diarrhoea
Weight loss
Increased appetite
Overactive
Sweats
Heat intolerance
Palpitations
Tremor
Irritability 
Labile emotiona
Oligomenorrhoea
Infertility
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2
Q

What investigations in thyrotoxicosis?

A

TFTs:
TSH low
T3 and T4 up

FBC: mild normocytic anaemia, mild neutropenia in Graves’
Raised ESR
Raised Ca
Raised LFTs

Check thyroid autoantibodies

test visual fields,a city and eye movements if eye disease

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3
Q

What are signs of thyrotoxicosis?

A
Fast/irregular pulse
Warm moist skin
Fine tremor
PAlmar erythema
Thin haie
Lid lag
Lid retraction (exposure of sclera above iris
May be goitre
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4
Q

What are signs of Graves’ disease?

A

Eye disease - exophthalmos, ophthalmoplegia

Pretibial myxoedema: oedematous swellings above the lateral malleoli

Thyroid acropachy: extreme manifestation with clubbing, painful finger and toe swelling and periosteal reaction (formation of new bone) in limb bones

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5
Q

What is Graves’ disease

A

Circulating IgG antibodies bind to and activate GPCR thyrotropin receptors which cause smooth thyroid enlargement and increased hormone production , especially T3

Triggers: Stress, infection, childbirth

Patients are often hyperthyroid

Associated with other autoimmune diseases: vitiligo, T1DM, Addison’s

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6
Q

What is toxic multi nodular goitre?

A

Seen in elderly and in iodine deficient areas

Nodules that secrete thyroid thormone.

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7
Q

What is toxic adenoma?

A

Solitary nodule producing T3 and T4

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8
Q

What an be the cause of exogenous hyperthyroidism

A

Iodine excess e.g. food contamination, contrast medium.

Levothyroxine excess causing raised T4, low T3 and low thyroglobulin.

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9
Q

What drugs can cause hyperthyroidism?

A

Amiodarone

Lithium (hypothyroidism is more common)

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10
Q

What is the pharmacological management for thyrotoxicosis?

A

Beta-blockers (propanolol) for rapid control of symptoms
Anti-thyroid medication:

A titration - carbimazole for 4 weeks, reducing according to TFTs every 1-2 months

B Block-replace
Carbimazole and levothyroxing simultaneously (less risk of iatrogenic hypothyroidism)

In Graves’ maintain on either for 12-18 months then withdraw

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11
Q

What are side effects of carbimazole?

A

Agranulocytosis (neutropenia can lead to sepsis)

Warn to stop and get an urgent FBC if signs of infection e.g. fever, sore throat, ulcers

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12
Q

What other management of thyrotoxicosis?

A

Radioiodine: most become hypothyroid post-treatment
CI: pregnancy, lactation

Thyroidectomy (usually total): Carries risk of damage to recurrent laryngeal nerve (hoarse voice) and hypoparathyroidism.
Patients will become hypothyroid so thyroid replacement is needed

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13
Q

What are complications of hyperthyroidism?

A
Angina
Heartfailure (thyrotoxic cardiomyopathy)
Angina
AF
Ostoporosois
Thyroid storm (thyrotoxic crisis)
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14
Q

What are signs an symptoms of thyroid storm?

A
Severe hypothyroidism
Fever
Agitation
Confusion
Coma Tachycardia
AF
Diarrhoea and vomiting
Goitre
Thyroid bruit
Acute abdomen
Heart failure
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15
Q

What precipitates thyroid storm?

A

Recent thyroid surgery or radioiodine,
infection
MI
Trauma

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16
Q

How to trat thyroid storm

A

Contact endocrinology
Bloods for T3, T4. TSH
IV access - fluids

Beta blocker - propranolol if no contraindication (e.g. asthma/poor cardiac output) - diltiazem if CI

High dose digoxin to slow the heart

Carbimazole to block thyroid

Hydrocortisone IV or dexamethasone PO to prevent peripheral conversion of T4 to T3

Treat infection

17
Q

What re symptoms of thyroid eye disease?

A

Eye discomfort, grittiness, increased tear production, photophobia, diplopia, reduced acuity, relative afferent pupillary defect (RAPD) - patients pupils contract less when bright light is swung from unaffected to affected light so appearing to dilate –> may mean optic nerve compression

18
Q

What are signs of thyroid eye disease?

A

Exophthalmos - appearance of protruding eye
Proptosis - eyes protrude beyond the orbit (look from above in the same plane as the forehead)
Conjunctival oedema
Corneal ulceration
Papilloedema
Loss of colour vision
Ophthalmoplegia especially of upward gaze due to muscle swelling and fibrosis

19
Q

How to manage thyroid eye disease?

A

Treat hyper/hypothyroidism
Stop smoking
Symptomatic treatment - artificial tears, sunglasses’ cord dust

If severe high dose steroids

Surgical decompression for severe sight threatening disease