Hyperthyroidism - Grave's Disease

Question 1

What are the causes of hyperthyroidism?

Answer 1

Primary = pathology in thyroid gland

Secondary = thyroid gland excessively stimulated by TSH

• Graves most common caused by TSH receptor antibodies
• Toxic nodular goitre
• Viral thyroiditis

Question 2

What are the risk factors for hyperthyroidism?

Answer 2

Female
FHx autoimmune thyroid disease
Increased iodine uptake
Lithium/cytokine therapy
Stress
Radiation
Tobacco use

Question 3

What are the symptoms of hyperthyroidism?

Answer 3

Weight loss
Sweating
Heat intolerance
Moist velvety skin
Hair loss
Neck swelling
Eye bulge
Insomnia
Diarrhoea
Altered.                                                                                                                    menstruated cycle

Question 4

What are the signs of hyperthyroidism?

Answer 4

HANDS
Acropachy
Onchyolysis
Tremor

FACE
Hair loss
Eye disease (peri-orbital oedema, exophthalmos, proptosis, dry eyes)aa

CARDAIC
Tachycardia
Palpitations
Cardiac flow murmur

NECK
Diffuse goitre
Thyroid bruit

Pretibial myxoedema

Question 5

What is the investigations for hyperthyroidism?

Answer 5

BLOODS (gold)
TSH = LOW
T4/T3 free = HIGH
TSH antibodies = +ve

IMAGING
Thyroid US = highly vascular, diffuse, enlarged
Radioactive iodine uptake = increased

BIOPSY
Skin = thyroid dermopathy

Question 6

What is the management of hyperthyroidism?

Answer 6

Symptomatic relief
-Beta-blockers = propranolol/atenolol

Antithyroid drugs

• Carbimazole
• Propylthiouracil (if pregnant as less chance crossing placenta barrier)

Resection

• Radioiodine (sleep alone 1 week, avoid pregnant women 4 months, avoid children, may worsen eye disease)
• Subtotal/total thyroidectomy

Viral thyroiditis

• Analgesia
• Steroids

Question 7

What are the signs of a thyrotoxicosis crisis?

Answer 7

N+V & Diarrhoea
Hyperpyrexia (>41 degrees)
Tachycardia (>140)
Atrial fibrillation
Abdominal Pain
Seizures/psychosis/agitation
Jaundice
Coma

Question 8

How should thyrotoxicosis crisis be treated?

Answer 8

1. Treat underlying cause
2. ABC resus: fluids, O2, NG tube if vomiting
3. Oral carbimazole/propylthiouracil
4. Beta-blockers (diltiazem if contraindicated)
5. Corticosteroids (block T4 to T3 conversion)

Question 9

What are the features of Subacute (De Quervan’s) thyroiditis?

Answer 9

• Occurs after viral infection
• Hyperthyroidism initially followed by prolonged hypothyrodism
• Painful goitre
• Raised ESR
• Globally reduced uptake on iodine 131 scan