Thyrotoxicosis

Question 1

Causes

Answer 1

Grave’s disease

Toxic nodular goitre

Acute phase of subacute thyroiditis

Acute phase of post-partum thyroiditis

Acute phase of Hashimoto’s thyroiditis

Amiodarone therapy

Contrast

Question 2

Universal features of hyperthyroidism

Answer 2

Anxiety and irritability

Sweating and heat intolerance

Tachycardia and palpitations

Weight loss

Fatigue

Frequent loose stools

Sexual dysfunction

Oligomenorrhoea

Question 3

Grave’s disease

Answer 3

Autoimmune

TSH receptor antibodies are abnormal antibodies that mimic TSH

Most common cause of thyrotoxicosis

Question 4

Toxic multinodular goitre

Answer 4

Plummer’s disease

Nodules act independently of normal feedback system

Question 5

Unique features of Grave’s disease

Answer 5

Diffuse goitre (without nodules)

Graves eye disease

Bilateral exopthalmos

Pretibial myxoedema

Question 6

Unique features of toxic multinodular goitre

Answer 6

Goitre with firm nodules

Most patients over 50

Second most common cause of thyrotoxicosis

Question 7

Solitary toxic thyroid nodule

Answer 7

Single abnormal thyroid nodule acting alone to release thyroid hormone

Usually benign adenomas

Treated with surgical removal

Question 8

De Quervain’s thyroiditis

Answer 8

Presentation of viral infection with fever, neck pain and tenderness, dysphagia and hyperthyroidism

Hyperthyroid phase followed by hypothyroid phase as TSH falls due to negative feedback

Self-limiting condition

Supportive treatment with NSAIDs for pain/inflammation and beta-blockers for hyperthyroid symptoms

Question 9

Thyroid storm

Answer 9

More severe presentation of hyperthyroidism with pyrexia, tachycardia and delirium

Requires admission for monitoring

May need fluid resuscitation, anti-arrhythmic medication and beta-blockers

Question 10

First line management

Answer 10

Carbimazole 40mg and reduced gradually to maintain euthyroidism

Typically 12-18months

Question 11

Carbimazole complication

Answer 11

Agranulocytosis

Question 12

Radioactive iodine

Answer 12

Drink single dose of iodine and taken up by thyroid gland

Emitted radiation destroys proportion of thyroid cells

Reduction in functioning decreases thyroid hormone production

Remission can take 6 months

Question 13

Rules for radioactive iodine

Answer 13

Must not be pregnant/ can’t get pregnant within 6 months

Avoid close contact with children and pregnant women for 3 weeks

Limit contact with anyone for several days after dose

Question 14

Beta blockers

Answer 14

Used to block adrenaline related symptoms

Propanolol non-selectively blocks adrenergic activity

Particularly useful for patients with thyroid storm