what is thyrotoxicosis?
the clinical effect of ↑T4, usually from gland
hyperfunction.
symptoms of thyrotoxicosis
- Diarrhoea
- ↑ appetite but ↓ wt.
- Sweats, heat intolerance
- Palpitations
- Tremor
- Irritability
- Oligomenorrhoea ± infertility
signs of thyrotoxicosis in the hands
- Fast / irregular pulse
- Warm, moist skin
- Fine tremor
- Palmer erythema
signs of thyrotoxicosis in the face
- thin hair
- lid lag
- lid retraction
signs of thyrotoxicosis in the neck
goitre or nodules
signs specific to Graves
- Ophthalmopathy
- Exophthalmos
- Ophthalmoplegia: esp. up-gaze palsy
- Eye discomfort and grittiness
- Photophobia and ↓ acuity
- Chemosis - Dermopathy: pre-tibial myxoedema
- Thyroid acropachy
investigations in thyrotoxicosis
Bloods: -↓TSH, ↑T4/↑T3 - Antibodies: TSH receptor, TPO - ↑Ca, ↑LFTs Isotope scan - ↑ in Graves’ - ↓ in thyroiditis Ophthalmopathy: acuity, fields, movements
most common cause of thyrotoxicosis?
Graves disease
triggers of Graves disease
- stress
- infection
- child-birth
conditions associated to Graves disease
- type 1 diabetes mellitus
- vitiligo
- Addison’s
other causes of thyrotoxicosis
- toxic multinodular goitre (Plummer’s disease)
- toxic adenoma
- thyrotoxic phase of thyroiditis (Hashimoto’s, de Quervain’s, subacute lymphocyctic)
- drugs (thyroxine, amiodarone)
medical treatment for thyrotoxicosis
- Symptomatic: β-B (e.g. propranolol 40mg/6h)
- Anti-thyroid: carbimazole (inhibits TPO)
- Titrate according to TFTs or block and replace
- In Graves’ Rx for 12-18mo then withdraw
(~50% relapse → surgery or radioiodine)
- SE: agranulocytosis
radiological treatment for thyrotoxicosis
radio-iodine
- most become hypothyroid
- contraindicated in pregnancy and lactation
surgical treatment for thyrotoxicosis
thyroidectomy
- recurrent laryngeal nerve damage → hoarseness
- hypoparathyroidism
- hypothyroidism
what is a thyroid storm?
thyrotoxic crisis
- acute, life-threatening, hypermetabolic state induced by excessive release of thyroid hormones (THs) in individuals with thyrotoxicosis.
clinical features of thyroid storm
- ↑ temp
- Agitation, confusion, coma
- Tachycardia, AF
- Acute abdomen
- Heart failure
precipitants to thyroid storm
- Recent thyroid surgery or radio-iodine
- Infection
- MI
- Trauma
treatment for thyroid storm
- Fluid resuscitation + NGT
- Bloods: TFTs + cultures if infection suspected
- Propranolol PO/IV
- Digoxin may be needed
- Carbimazole then Lugol’s Iodine 4h later to inhibit thyroid
- Hydrocortisone
- Rx cause
