Hyperthyroid

Question 1

What are the causes of hyperthyroid?

Answer 1

Graves disease (autoimmune) 
Toxic multi nodular goitre 
Drug induced 
Toxic adenoma 
Exogenous iodine 
Subacute de Quervain's thyroiditis 
Ectopic thyroid tissue

Question 2

What are the signs and symptoms of hyperthyroidism?

Answer 2

irritability/labile emotions 
weight loss 
diarrhoea 
heat intolerance/sweating 
abnormal menstrual cycles
palpitations 
tremor 
increased appetite 
tachycardia/irregular pulse 
palmar erythema 
lid lag/lid retraction 
brisk reflexes 
thin hair 
\+/- goitre

Question 3

What are the investigations required for hyperthyroidism?

Answer 3

TFTs

for suspected autoimmune conditions: thyroid auto-anitbodies, antithyroid peroxidase antibodies, TSH receptor antibodies

Question 4

What would TFTs show in hyperthyroidism?

Answer 4

decreased TSH

increased T4 and T3

Question 5

What are the management options in hyperthyroidism?

Answer 5

Carbimazole
Beta-blockers
Radio-iodine
Thyroidectomy

Question 6

What is carbimazole?

Answer 6

antithyroid medication

Question 7

What are the two strategies of using carbimazole?

Answer 7

Titration - initial dose 20-40mg, PO, for 4/5, dose reduced according to TFTs monthly

Block and replace - given simultaneously w/thyroxine, less risk of iatrogenic hypothyroidism

Remission after 18-24 months (50% relapse)

Question 8

What are beta blockers used for?

Answer 8

propanolol - symptomatic control

reduces tremors, palpitations, sweating, agitation, anxiety

Question 9

What are the complications of hyperthyroidism?

Answer 9

graves orbitopathy 
thyroid storm 
atrial fibrillation 
heart failure 
reduces bone mineral density 
increased mortality rate

Question 10

What are the signs of thyrotoxicosis?

Answer 10

agitation, fine tremor, warm moist skin, palmar erythema
sinus tachycardia, AF, HF, dependent oedema
eye signs
goitre

Question 11

When should patients with hyperthyroidism be referred?

Answer 11

all people with overt hyperthyroidism