Thyroid

Question 1

What is this a presentation of?
Diarrhoea, weight loss, increase in appetite, sweating, heat intolerance, palpitations, tremor, irritability, labile emotions, oligomenorrhea, infertility, tachycardia, warm and moist skin, thin hair, lid lag, lid retraction, goitre.

Answer 1

Hyperthyroidism

Question 2

What are the typical blood results in hyperthyroidism?

Answer 2

1. Supressed TSH, raised T4 and T3

2. Raised calcium, LFTs, mild normocytic anaemia

Question 3

What are the causes of hyperthyroidism?

Answer 3

1. Grave’s - eye disease, pretibial myxoedema, thyroid acropachy.
2. Toxic multinodular goitre - seen in elderly and iodine deficiency areas.
3. Toxic adenoma - solitary nodule, on isotope nodule is hot, rest is suppressed.
4. Subacute de Quervain’s - self-limiting post-viral with painful goitre, fever, raised ESR. Low isotope uptake on scan.
5. Amiodarone, lithium

Question 4

What is the medical treatment for hyperthyroidism?

Answer 4

1. Beta blockers - propranolol for rapid control of symptoms
2. Block and replace - carbimazole (can cause agranulocytosis) and levothyroxine simultaneously
3. Radioiodine - multinodular goitre, hypothyroid after, do not use in pregnancy/lactation/active hyperthyroidism (can cause thyroid storm)

Question 5

What is the surgical management for hyperthyroidism and what are the risks involved?

Answer 5

1. Thyroidectomy

2. Damage to recurrent laryngeal nerve (hoarse voice) and hypoparathyroidism

Question 6

What is this a presentation of?

Severe hyperthyroidism, fever, agitation, confusion, coma, tachycardia, AF, D&V, acute abdomen.

Answer 6

Thyroid storm

Question 7

What is the management for thyroid storm?

Answer 7

1. Bloods - TSH, T4, T3
2. Propranolol
3. Carbimazole
4. Hydrocortisone

Question 8

What is this a presentation of?
Tiredness, lethargic, low mood, cold intolerance, weight gain, constipation, menorrhagia, hoarse voice, reduced memory or cognition, dementia, myalgia, cramps, weakness, bradycardia, slow reflexes, ataxia, dry thin hair, yawning, cold hands, ascites, neuropathy.

Answer 8

Hypothyroidism

Question 9

What are the typical blood results suspected hypothyroidism?

Answer 9

1. Raised TSH, low T4

2. Raised TC and TG

Question 10

What are the causes of hypothyroidism?

Answer 10

1. Hashimoto’s thyroiditis - autoantibodies high
2. Primary atrophic hypothyroidism - no goitre
3. Post-thyroidectomy or radioiodine treatment
4. Antithyroid drugs, amiodarone, lithium, iodine
5. Subacute thyroiditis - temporary closed eye orgasm after hyperthyroid phase
6. Iodine deficiency chief cause worldwide

Question 11

What is the treatment for hypothyroidism?

Answer 11

1. Healthy and young - levothyroxine 1.5mcg/kg, adjust six weekly depending on clinical state but not to suppress TSH.
2. IHD/elderly - start 25mcg/d and titrate up 25mcg/4 weeks.

Question 12

What is this a presentation of?

Often >65 years old, hypothermia, hyporeflexia, hypoglycaemia, bradycardia, coma, seizure.

Answer 12

Myxoedema coma

Question 13

What is the management for myxoedema coma?

Answer 13

1. Bloods - T3, T4, TSH, cortisol, glucose
2. ABG
3. Give T3 (liothyronine)
4. Give hydrocortisone