FN: Thyrotoxicosis Flashcards Preview

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Flashcards in FN: Thyrotoxicosis Deck (26):
1

Definition

The clinical effect of a high t4, usually form gland hyperfunction

2

Symptoms

Diarrhoea
Increased appetite but wt. loss
Sweats, heat intolerance
Palpitations
Tremor
Irritability
Oligomenorrhoea ± infertility

3

Signs: hands

Fast/irregular pulse
Warm, oist skin
Fine tremor
Palmer erythmea

4

Signs: face

Thin hair
Lid lag
Lid retraction

5

Signs: NEck

Goitre or nodules

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Graves specific: opthalmology signs

Exophthalmos
Opthalmoplegia: esp. up-gaze palsy
Eye discomfort and grittiness
Photophobia and grittiness
Photophobia and reduced acuity
Chemosis

7

Graves: Dermopathy

pre-tibilar myxoedema

8

Graves thyroid signs

Acropachy nails

9

General Investigations and findigns

1. reduced TSH, raised t3/T4
2. Abs: TSH receptor, TPO
3. Raised Ca, raised LFTs
4. Isotope scan (increased in graves, reduced in thyroiditis
5. Opthalmopathy: acuity, fields, movements

10

Graves disease epi.

1. 60% of cases of thyrotosicosis
2. Prev: 0.5%
3. Sex: F>>M = 9:1
4. Age: 40-60yrs

11

Graves features

1. diffuse goitre with raised iodine uptake
2. Opthalmopathy and dermopathy
3. Triggers: stress, infection, child-birth

12

Graves associations

1. T1DM
2. Vitilgo
3. Addisons

13

Other causes of thyrotoxicosis

1. Toxic multinodular goitre = plummers disease
2. Toxic adenoma
3. Thyrotoxic phase of thyroiditis
4. Drugs

14

Toxic multinodular goitre

Autonomous nodule develops on background multinodular goitre
Elderly and iodine - dificient areas
3. Iodine scan shows hot nodules

15

Toxic adenoma

Solitaryhot nodule producing T3/T4
Most nodules are non-functional

16

Thyrotoxic Phase of Thyroiditis

Hasimotos
de Quervains
Subacute lymphocytic

17

Drugs

Thyroxine
Amiodarone

18

Treatment medical

Symptomatic:Beta-blockers (e.g. propranolo 40mg/6h)
nti-thyroid: carbimazole (inhibits TPO)

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Carbimazole

1. titrae according to TFTs or block and replace
2. In graves' Rx for 12-18mo then withdraw - 50% relapse --> surgery or radioiodine

20

Carbimazole SE

Agranulocytosis

21

Thyrotoxicosis radiological:

Radio-iodine
1. Most become hypothyroid
2. CI: pregnancy, lactation

22

Thyrotoxicosis: surgical

Thyroidectomy
Recurrent laryngeal N. damage
Hypoparathyroidism
Hypthryoidism

23

Thyroid storm features

raised temp
agitation, confusion, coma
Tachy, AF
Acute abdomen
HF

24

Thyroid storm precipitants

Recent thyroid surgery or radio-iodine
Infection
MI
Trauma

25

RX: thyroid storm

Fluid resuscitation +NGT
2. Bloods: TFTs + cultures if infection suspected
3. Propranolo PO/IV
4. digoxin may be needed

26

RX: thyroid storm

Fluid resuscitation +NGT
2. Bloods: TFTs + cultures if infection suspected
3. Propranolo PO/IV
4. Digoxin may be needed
5. Carbimazole then lugols iodine 4h later to inhibit thyroid
6. Hydrocortisone
7. Rx cause

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