What are the symptoms of hyperthyroidism?
- Weight loss despite increased apetite
- Palpitations/ rapid pulse
- Sweating and heat intolerance
- Tiredness and weak muscles
- Nervousness, irritability and shakiness
- Mood swings or aggressive behaviour
- Frequent loos bowel movements
- Warm, moist hands
- Passing larger than usual amounts of urine
- An enlarged thyroid gland (can be in hypo as well tho)
What are some of the classic eye features seen in hyperthyroidism ?
- Lid retraction
- Lid lag chemosis
- Visual loss
What is the thyroid antibody which is associated with hyperthyroidism mainly ?
TSH receptor antibody
What are the causes of hyperthyroidism ?
Autoimmune graves disease
Nodular thyroid - Multi-nodular goitre, toxic nodule
- Iodine - supplement, amiodarone, thyroxine
- Medications - lithium, amiodarone, thyroxine
What drug can cause both hypothyroidism and hyperthyroidism ?
What is a thyroid storm ?
Severe hyperthyroidism. Emergency
What are the symptoms of a thyroid storm ?
What is the management of thyroid storm ?
- Lugols iodine
- Glucocorticoids (calm down immune system)
- Fluid monitoring
What is the treatment of hyperthyroidism ?
- Propylthiouracil (if pregnant)
- B-blocker for rapid control of symptoms
50% of patients will relapse after oral treatment for hyperthyroidism - what can be done for those who relapse ?
What does radioiodine therapy carry a big risk of ?
Causing the patient to develop hypothyroidism
What is thyroiditis ?
It is inflammation of the thyroid gland which can either cause high or low levels of thyroid hormone
What are the different types of thyroiditis ?
- DeQuervians (sub-acute (viral))
- Post-partum (after pregnancy)
- Drug-induced - amiodarone, lithium
- Acute thyroiditis/supprative (bacterial)
Describe what sub-acute/ De-Quervians is ?
- May be triggered by viral infection
- May have associated sore throat and viral symptoms e.g. fever
- Usually self-limiting
What are the thyroid hormone results of sub-acute thyroiditis/ De-Quervians?
- T4 high and TSH low in early stage
- T4 low and TSH high in late stage
- The results then normalise
Refer to case 7 slide 53 for example
How common is amiodarone induced thyroid dysfunction?
- 2% will develop thyrotoxicosis
- 13% will develop hypothyroidism
What are the thyroid hormone results for primary, sub-clinical and secondary hyperthyroidism ?
- Primary - TSH low, T4/T3 high
- Sub-clinical - TSH low, T4/T3 normal
- Secondary - TSH high, T4/T3 high
Have a look at the cases at the end of this lecture
They are good