Thyrotoxicosis

Question 1

Graves disease is characterised by

Answer 1

Diffuse goiter - چةو-پوست

Question 2

…………..Ab is specific for graves disease .

Answer 2

Thyroid stimulating immunoglobulin (TSI) Or Thyrotropin receptor Ab (TRAB) .

Question 3

Apathetic thyrotoxicosis

Answer 3

In elderly features maybe subtle or masked

Question 4

اعراض هايپر

Answer 4

قرمزبوونةوةي راحة اليد
شرى
خورة
Onycholysis
Diffuse hyperpigmentation **
Diffuse alopecia
Vitiligo
Fine tremor
AF is more common in >50y
Hypokalemic periodic paralysis
Hepatic dysfunction/hepatomegaly

Increased excretion of ca and p in urine and stool
Mild hypercalcemia 20 %
Hypercalciuria is more common
Osteopenia
Small increase in fracture rate
👆(RBC ,EPO,Production,plasma) =normal hematocrit
زيادبووني خلايا مناعية بيجگة لة نوتروفيل
Proximal myopathy
Muscle wasting

Question 5

BP In hypo and hyperthyroidism

Answer 5

1/👆diastolic P,narrowingPP
2/👆systolic p, widening PP

Question 6

Effects of hypothyroidism on reproductive sys

Answer 6

Misscariage in women
Gynecomastia in man

Question 7

Thyroid dermopathy /Pretibial myxedema

Answer 7

If extend the whole lower leg and foot (🦶 +🦵) =Elephantiasis

Question 8

Acropachy

Answer 8

Strongly associated with dermopathy

Clubbing of the fingers and toes with soft tissue swelling

Subperiosteal new bone formation

Question 9

Laboratory evaluation

Answer 9

(TSH👇 /هميشة
(يا T4ياT3بالا يا جفتشون

Checking Trab ……>specific for graves

Question 10

Follow up in hyperthyroidism

Answer 10

3-4week
With free T4/first 4months
After that T4 +TSH

Question 11

Treatment

Answer 11

1/Anti thyroid drug((first line treatment))
Propyl-thio-uracil /inhibit deiodination
Carbimazole+methimazole+propylthiouracil ………>👇thyroid Ab +inhibit TPO

2/ Ablation ……>👇Thyroid tissue by surgery or radioiodine (131I)

اگر جواب نةيةد وة دارو يان گويتةري فرة گةورابوود يا دووبارة پركاري بادةو ……>ablasion

👆chance of recurrency in graves

Question 12

Thyrotoxicosis caused by medication,Rio is ………..

Answer 12

👇

Ex/due to medications or thyrotoxicosis

Question 13

TSH👇
(T3 +T4)……>normal

Answer 13

Subclinical hyper

علاج نيتواد اگر غير عرضيية ، الا اذا يكيگ بتواد حاملة بوود يان مشاكل دل ديرد

Follow up 6-12mo

Question 14

Dermopathy mimicking

Answer 14

Elephantiasis

Question 15

Rare but major side effects of anti-thyroid drugs

فورا لازم قطع الدواء

Answer 15

Agranulocytosis
SLE -like syndrome
Hepatitis +cholecystitis

Question 16

How to avoid thyrotoxic crisis before thyroidectomy

Answer 16

Potassium iodide is needed prior to surgery

Question 17

Toxic MNG tests shows

Answer 17

Subclinical hyperthyroidism
👇TSH
(T3+ T4)=normal
Age👆
Treatment choice =ablation with radioactive or surgery (must first be euthyroided with antithyroid drugs).
Surgery specially if the nodule is greater than 4cm
Or treatment with radiographic ablation or ethanol injection under ultrasound guidance.

Question 18

Secondary hyperthyroidism

Answer 18

👆TSH /👆(T3 +T4)
TSH=nor /👆(T3+T4)

لازم چيك كردن محوةرةگان تر أو imaging

Question 19

Subacute thyroiditis =viral=de quervain=granulomatous

Answer 19

Previous upper respiratory infection 2-3mo

High chance of recurrency

TFT ……like hyper primary ((emptying gland storage)) then may become hypothyroidism .

Question 20

Acute thyroiditis
TFT:
Clinical picture
Diagnosis +treatment

Answer 20

Normal
Pain+lymphadenopathy
FNA……>Culture……>Antibiotic
Abscess driange or thyroidectomy

Question 21

Post partum thyroiditis
3-6month after delivery

Answer 21

Almost with positive TPO + DM1+Depression after giving birth 🤰

They pass transient hyperthyroidism /2-4week in this phase should not be given anti-thyroid drugs (just beta blockers for tachycardia).

Some may develop hyperthyroidism