hyperthyroidism
high T3 and T4
low TSH
increased metabolism and energy
signs and symptoms
hyperactivity
anxiety and irritation
insomnia and tiredness
heat sensitivity
weight loss
diarrhoea
polyurea
palpitations
goitre
treatment
First line - carbimazole
MHRA
- congenital malformations- contracetpion
- acute pancreatitis
- Bone marrow suppression
propylthiouracil
CI in liver disorder - jaundice, dark urine, nausea
BB - help with symptomatic relief such as palpitations, irritability anxiety etc
Graves disease
first line
radioactive iodine
- if remission likely to be achieved with antithyroids - can consider carbimaxole
- use carbimazole if iodine and surgery unsuitable
— given as a block and replace regimen in combo with levothyroxine for 12-18 m
pregnancy
- propylthiouracil - trying to become pregnant in next 6 m
- after radioactive iodine treatment, avoid pregnancy for 6 m- men avoid for 4 m
Hypothyroidism
low T3 and T4
high TSH
decreased metabolism and activity
signs and symptoms
- tiredness
- weight gain
- depression
- constipation
- intolerance to cold
- dry skin s
- menstural irregularities
treatment hypothyroid
1st line
levothyroxine
- monitor TSH every 3 months until stable, then yearly
- take in morning, at least 30 mins before anything else
MHRA - new guidance that small portion of patients feel symptoms when differing brands
LIOTHYRONINE
- do not routinely offer - either alone or combination with levo
levothyroixine interactions
antacids, calcium, aluminium, mg - reduces absorbtion of levothyroxine -4hr gap
affected by CYP 450 - inhib and indu
may cause hypERglycaemia - reducing antidiabetic treatment
ferrous sulphate reduces absorbtion - 2 hr gap
orlistat - may decrease levo absorbtion
