hyperthyroidism

Question 1

Hyperthyroidism

Signs and Symptoms of Hyperthyroidism:

Neuropsych
Neuromuscular
Skin/Hair
Voice
Weight
CVS
Goitre 
Hot/Cold/diaphoresis 
Eyes
GI
Pituitary fntn

Answer 1

Neuropsych
 - anxiety, irritability, restlessness
 - FATIGUE, restless sleep
 - increased appetite
 - decreased attention 
Neuromuscular 
- tremors
- proximal muscle weakness
- hyperreflexia
Skin/Hair 
- uniform hair loss (thin & silky) 
Voice
 - no change
Weight
 - loss
CVS
 - palpitations 
 - tachycardia 
 - A Fib 
 - Isolated SYST BP 
Goitre 
- Yes
Hot/Cold/diaphoresis 
- Hot intolerance, inceased sweating 
Eyes
- blurred/double vision
- dry eyes, proptosis, conjunctivitis, dysconjugate gaze
GI 
- increased BMs 
Pituitary fntn
 - amenorrhea/oligomenorrhea

Question 2

Hyperthyroidism

Complications of excess thyroid hormone

Answer 2

• osteoporosis
• thyroid storm
• CP due to decompensated heart disease

Question 3

Hyperthyroidism

Thyroid storm

Answer 3

• HR > 140
• tachyarrythmias
• hypotension/shock/death
• hyperpyrexia (T > 40)
• ALC (agitation, psychosis, delirium, anxiety)
• GI: N/V/D/abdo pain/hepatic failure/jaundice
• may have mild hyperglycemia, mild hypercalcemia, leukocytosis/penia, abnormal LFTs.

Question 4

Hyperthyroidism

Lab monitoring for hyperthyroidism (following initial dx)

Answer 4

TSH, T4 Q 4-6 weeks, CBC & LFT’s baseline and at 1 week

Question 5

Hyperthyroidism

Referral for hyperthyroidism

Answer 5

Endo, ENT surgeon, obs/gyne if pregnant, opth if ocular involvement

Question 6

Hyperthyroidism

What is the first-line pharm tx for hyperthyroidism (Generic/Classification/MOA/adverse rxn)

Answer 6

• methimazole
• Thionamides
• inhibits thyroid hormone synthesis
• averse rxn: agranulocytosis, neutropenia, reversible cholestatic jaundice

Question 7

Hyperthyroidism

Causes of high TSH and high fT4

Answer 7

• pituitary disease (ant pituitary adenoma)

- resistance to thyroid hormone

Question 8

Hyperthyroidism

Causes of low TSH, elevated fT4

Answer 8

• excessive exogenous levothyroxine
• Grave’s (most common)
• subacute thyroiditis (post viral)
• Painless/postpartum thyroiditis (autoimmune)
• toxic multinodular goitre

Question 9

Hyperthyroidism

Causes of low TSH, normal fT4, elevated fT3

Answer 9

• T3 thyroitoxicosis (autonomous nodule)

- excessive hormone replacement (liothyrionine or desiccated thyroid)

Question 10

Hyperthyroidism

Causes of subclinical hyperthyroidism (low TSH, normal fT4/fT3)

Answer 10

• recovery
• pregnancy
• assay artefact

Question 11

Hyperthyroidism

What lab test is methimazole dosing based on?

Answer 11

fT4 (or fT3 if thyroitoxicosis)

*TSH may be suppressed for protracted periods