Management of De Quervain’s thyroiditis
- self-limiting condition
- NSAIDs for pain and inflammation
- beta- blockers - for symptomatic relief of hyperthyroidism
Thyroid storm
- another name
- what thyroid disorder it is associated with
Thyroid storm = thyrotoxic crisis
Associated with hyperthyroidism
Presenting features of thyroid storm (3)
- pyrexia
- tachycardia
- delirium
Management of thyroid storm
thyroid storm = severe presentation of hyperthyroidism
Management:
- admission for monitoring
- treated the same way as any other presentation of thyrotoxicosis
- may need supportive care with fluid resuscitation, anti-arrhythmic medication and beta blockers
First line drug in treatment of hyperthyroidism
Carbimazole
Two approaches in hyperthyroidism treatment with Carbimazole
- titration- block: the dose is titrated to maintain normal levels (some production still occurs)
- block and replace: the dose is sufficient to block all the production -> pt takes levothyroxine
2nd line drug for hyperthyroidism
*why is it not preferred?
Propylthiouracil
*used in a similar way to carbamazepine
* small risk of severe hepatic reaction (including death)
The principle behind radioactive iodine treatment of hyperthyroidism
- single dose of radioactive iodine is drunk -> it is taken up by thyroid gland -> emitted radiation destroys a proportion of thyroid cells
Result: reduction in thyroid cells -> less thyroid hormone is produced
*it may take 6 months for the remission of hyperthyroid
What may happen to a patient who is treated with radioactive iodine for the hyperthyroidism?
Potentially patient may become hypothyroid - levothyroxine replacement needed
Strict (3) rules re hyperthyroidism treatment with radioactive iodine
- Must not be pregnant and are not allowed to get pregnant within 6 months
- Must avoid close contact with children and pregnant women for 3 weeks (depending on the dose)
- Limit contact with anyone for several days after receiving the dose
which beta-blocker is used in hyperthyroidism or thyroid storm?
Propranolol is a good choice because it non-selectively blocks adrenergic activity as opposed to more “selective” beta blockers the work only on the heart.
What’s a definitive treatment for hyperthyroidism?
- a definitive option is to surgically remove the whole thyroid or toxic nodules
- the patient will be left hypothyroid post thyroidectomy and require levothyroxine replacement for life
The most common cause of hypothyroidism in developed world
Hashimoto Thyroiditis
Pathophysiology of Hashimoto’s thyroiditis
Autoimmune inflammation of thyroid gland
Antibodies:
- antithyroid peroxidase (anti-TPO) antibodies
- anti-thyroglobulin
Initially, a goitre is present -> then atrophy of thyroid gland develops
(2) antibodies associated with Hashimoto’s
Hashimoto’s = hypothyroidism
- anti-peroxidase (anti-TPO)
- antithyroglobulin
What’s the most common cause of hypothyroidism in the developing world?
iodine deficiency
What else, apart from Hashimoto’s and iodine deficiency can cause hypothyroidism
Hypothyroidism may develop secondary to treatment for hyperthyroidism (any treatment may have potential to do so)
List treatments for hyperthyroidism (4)
- Carbimazole
- Prophylthiouracil
- Radioactive iodine
- Thyroid surgery
What medications (2) may cause hypothyroidism?
- Lithium - inhibits production of thyroid hormone
- Amiodarone - interferes with thyroid hormone production and metabolism (causes hypo or hyperthyroidism)
What’s secondary hypothyroidism
Possible causes
Hypothyroidism due to problems with pituitary gland (not enough TSH is produced)
Possible causes:
- Tumours
- Infection
- Vascular (e.g. Sheehan Syndrome)
- Radiation
TSH and T3/T4 levels in primary hypothyroidism
TSH and T3/T4 levels in secondary hypothyroidism
Features in hypothyroidism
- Weight gain
- Fatigue
- Dry skin
- Coarse hair and hair loss
- Fluid retention (oedema, pleural effusions, ascites)
- Amenorrhoea
- Constipation
