Thyroid Disorders — Quick Reference

HYPERTHYROIDISM Causes: • Graves disease — TSH receptor antibodies, diffuse goitre, ophthalmopathy, pretibial myxoedema • Toxic multinodular goitre — older patients • Toxic adenoma — single hot nodule • Subacute (de Quervain) thyroiditis — painful goitre, post-viral, ↑ ESR • Postpartum thyroiditis Symptoms: weight loss, heat intolerance, palpitations, anxiety, tremor, diarrhoea Investigations: ↓ TSH, ↑ T4/T3. TSH receptor antibodies for Graves. Treatment: carbimazole / methimazole, propranolol for symptoms, radioactive iodine, surgery HYPOTHYROIDISM Causes: • Hashimoto's — autoimmune, anti-TPO antibodies, painless goitre or atrophy • Iodine deficiency (Pakistan: still significant in some areas) • Post-radioactive iodine / post-thyroidectomy • Drugs: amiodarone, lithium Symptoms: weight gain, cold intolerance, fatigue, constipation, dry skin Investigations: ↑ TSH, ↓ T4 Treatment: levothyroxine Thyroid storm: extreme thyrotoxicosis. Beta-blocker + PTU + steroid + iodine Myxedema coma: severe hypothyroidism. IV T4, hydrocortisone