Thyrotoxicosis Flashcards
What are the symptoms of thyrotoxicosis?
- Diarrhoea; weight; appetite (if , paradoxical weight gain in 10%); over-active; sweats; heat intolerance; palpitations; tremor; irritability; labile emotions; oligo menorrhoea ±infertility. Rarely psychosis; chorea; panic; itch; alopecia; urticaria
What are the signs of thyrotoxicosis?
What are the signs of Graves’ disease?
What investigations are carried out to test for thyrotoxicosis?
- Low TSH, High T4 and T3
- Mild normocyctic anaemia
- Mild neutropenia (in Graves)
- Increased ESR, Calcium and LFTs
- Check for the presence of thyroid autoantibodies
What are the causes of thyrotoxicosis?
- Graves disease
- Toxic multinodular goitre
- Toxic adenoma
- Ectopic thyroid tissue
- Exogenous - iodine excess, levothyroxine excess
- Other
- Subacute de Quervain’s thyroiditis which is a self-limiting post viral with painful goitre
- Treat with NSAIDs
- Drugs
- Amiodarone
- Lithium
- Post-partum
- TB
- Subacute de Quervain’s thyroiditis which is a self-limiting post viral with painful goitre
What are the causes of Graves’ disease?
- Circulating IgG autoantibodies binding to and activating G- protein coupled thyrotropin receptors which cause smooth thyroid enlargement and increased hormone production
What are the triggers of Graves’ disease?
- Stress
- Infection
- Childbirth
How do patients with Graves’ disease present?
- Hyperthyroid
- May become hypothyroid or euthyroid
What is Graves’ disease associated with?
- Other autoimmune diseases:
- Vitiligo
- T1DM Addisions
How is thyrotoxicosis treated?
- Drugs
- Propranolol for symptom control
- Anti-thyroid medication
- Carbimazole
- Carbimazole and Levothyroxine
- Radioiodine
- Thyroidectomy
What are the side effects of carbimazole?
- Agranulocytosis
- Decreased neutrophils
What are the contraindications of radioiodine?
- Pregnancy
- Lactation
- Most patients become hypothyroid post treatment
What are the risks of thyroidectomy?
- Risk of damage to recurrent laryngeal nerve (hoarse voice)
- Hypoparathyroidism
- Patients will become hypothyroid so thyroid replacement is needed
What is thyroid eye disease?
- Thyroid eye disease (TED) is an eye condition in which the eye muscles and fatty tissue behind the eye become inflamed.
- This can cause the eyes to be pushed forward (‘staring’ or ‘bulging’ eyes) and the eyes and eyelids to become swollen and red.
- Rarely TED can cause blindness from pressure on the nerve at the back of the eye or ulcers forming on the front of the eyes.
- TED is an autoimmune disease. It occurs when the body’s immune system attacks the back of the eye and causes inflammation.
- It is mainly associated with an over-active thyroid due to Graves’ disease, although it does sometimes occur in people with an under-active or normally functioning thyroid.
What is the main risk factor of thyroid eye disease?
Smoking
What are the complications of thyrotoxicosis?
- Heart failure (thyrotoxic cardiomyopathy, increased in elderly)
- Angina
- AF
- Osteoporosis
- Opthalmopathy
- Gynaecomastia
- Thyroid storm
What are the symptoms of thyroid eye disease?
- Eye discomfort
- Grittiness
- Increased tear production
- Photophobia
- Diplopia
- Decreased visual acuity
What are the signs of thyroid eye disease?
- Exopthalmus
- Conjuctival oedema
- Corneal ulceration
- Papilloedema
- Loss of colour vision
- Opthalmoplegia (especially on upward gaze)
- Occurs due to muscle swelling and fibrosis
How is thyroid eye disease diagnosed?
- Clinical diagnosis
- CT/MRI of orbits may reveal enlarged eye muscles
How is thyroid eye disease managed?
- Get specialist help
- Treat hyper or hypo-thyroidism
- Smoking cessation
- Treat symptoms
- Surgical decompression
- Future options:
- Anti-TNF alpha antibodies
What are the causes of goitre?
- Diffuse:
- Physiological
- Graves disease
- Hashimoto’s thyroiditis
- Subacute de Quervain’s thyroiditis (painful)
- Nodular
- Multinodular goitre
- Adenoma
- Carcinoma
What can make thyroid eye disease worse?
Radioiodine treatment
