MANAGEMENT ENDOCRINE Flashcards
What is the management for hyperthyroidism?
Arrange emergency admission if serious complication
Arrange urgent endocrinology referral if disorder of pituitary or hypothalamus/thyroid disease is suspected, new onset hyperthyroidism, persistent subclinical hyperthyroidism (TSH levels are lower than 0.1mU/L at least 3 months apart)
Investigations: baseline FBC and LFTs, serum TSH, FT4, FT3 if TSH level is supressed, CRP/ESR for thyroiditis, thyroid autoantibodies (TRAbs/TSH receptor antibodies for graves), TPOAbs/thyroid peroxidase antibodies for post-partum thyroiditis
Imaging: ultrasound of neck if normal thyroid function but malignancy suspected
pharma options:
first line: beta blocker for adrenergic symptoms (palpitations, tachycardia, tremor), block and replace with carbimazole (block thyroid production) and levothyroxine (replace thyroid hormone)
second line: radioiodine (avoid prolonged contact with children and pregnant women, do not become pregnant within next 6 months, or father children for the next 4 months after treatment);
third line: thyroidectomy
MONITORING: TFTs and FBC (agranulocytosis (severe neutropenia) with carbimazole
non-operative: check TSH again in 3 months if subclinical hyperthyroidism is suspcted, seek immediate medical advice if pregnant, go on patient info, go to pharmacy about starting anti-thyroid drugs,
operative: thryoidectomy (e.g. malignancy, goitre causing compression of structures, first line or second line fail); need long term thyroid hormone replacement (LEVOTHYROXINE)
