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Thyroid Disease. Prof T O’Brien. Thyroid Hormone Excess Clinical Features. General Heat intolerance, fatigue, tremor. Cardiovascular Tachycardia, heart failure. Gastrointestinal Weight loss, diarrhoea Ophthalmological Lid lag, ophthalmopathy. Thyroid Hormone Excess Clinical Features.

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thyroid disease

Thyroid Disease

Prof T O’Brien

thyroid hormone excess clinical features
Thyroid Hormone ExcessClinical Features
  • General
    • Heat intolerance, fatigue, tremor.
  • Cardiovascular
    • Tachycardia, heart failure.
  • Gastrointestinal
    • Weight loss, diarrhoea
  • Ophthalmological
    • Lid lag, ophthalmopathy
thyroid hormone excess clinical features5
Thyroid Hormone ExcessClinical Features
  • Genitourinary
    • Amenorrhea, infertility.
  • Neuromuscular
    • Proximal muscle weakness, HPP, MG
  • Psychiatric
    • Irritability, agitation, anxiety, psychosis
  • Dermatological
    • Pruritus, hair thinning, onycholysis, vitiligo.
diagnosis
Diagnosis
  • High Free T4, T3 and supressed

sTSH

If sTSH is high suspect pituitary tumour or rare cases of thyroid hormone resistance

causes of thyroid hormone excess
Causes of Thyroid Hormone Excess
  • Increased radioactive iodine uptake
    • Graves
    • TMG
    • Toxic solitary adenoma
    • Pituitary tumour
causes of thyroid hormone excess8
Causes of Thyroid Hormone Excess
  • Reduced radioactive iodine uptake
    • Thyroiditis
    • Iodine induced (amiodarone)
    • Factitious
    • Struma ovarii
    • Thyroid carcinoma
graves disease
Graves Disease
  • Most common cause in Ireland
  • Diffuse Goitre
  • Hyperthyroidism
  • Ophthalmopathy
  • Dermopathy
  • Autoimmune. TSI.
slide13
TMG
  • Older
  • Usually less severe hyperthyroidism
  • May have subclinical hyperthyroidism
  • May have long history of goitre
toxic solitary adenoma
Toxic Solitary Adenoma
  • Rare cause (< 2% of patients with hyperthyroidism)
  • Younger people 30’s and 40’s
  • Scan
  • Benign follicular adenomas
thyroiditis
Thyroiditis
  • Painful (subacute, de Quervain’s)
  • Painless (post partum)
  • Hyperthyroid, hypothyroid and euthyroid phases
  • Anti thyroid drug therapy does not work
treatment of hyperthyroidism
Treatment of hyperthyroidism
  • Antithyroid drugs
    • Carbimazole 10 mg tid
    • Reduce to maintenance after 4 weeks
    • Rash, GI, agranulocytosis
    • Graves – withdraw drugs after course of treatment
treatment of hyperthyroidism17
Treatment of hyperthyroidism
  • Radio-iodine
    • Inflammatory response followed by fibrosis
    • May be used for Graves, TMG or TA
    • ? Need for drug treatment before and after
    • May need retreatment
    • Long term risk of hypothyroidism
treatment of hyperthyroidism18
Treatment of Hyperthyroidism
  • Surgery
    • Rarely used nowadays
    • Need to be rendered euthyroid before surgery
    • Lugol’s iodine 0.1-0.3 mls tid for 10 days before surgery
treatment of hyperthyroidism19
Treatment of Hyperthyroidism
  • Patient presents with hyperthryoidism
  • Make diagnosis, get RAI uptake.
  • Beta block (inderal 40-80 mg tid).
  • If RAI uptake is high – treat with RAI.
  • If RAI is low - symptomatic
thyroid storm
Thyroid Storm
  • Carbimazole (or PTU)
  • Inderal, 80mg qid
  • Iodine (Lugols 5 drops q6)
  • Dexamethasone 2mg q6
  • Other supportive measures
graves eye disease
Graves Eye Disease
  • Onset relative to hyperthyroidism is variable.
  • Pain, watering, photophobia, blurred vision, double vision
  • Usually mild – Tx, protective glasses, elevate head of bed, conjunctival lubricants
graves eye disease22
Graves Eye Disease
  • High dose steroids
  • External radiotherapy
  • Orbital decompression
hypothyroidism
Hypothyroidism
  • Hashimoto’s
  • Iatrogenic
  • Congenital
  • Hypopituitarism
treatment
Treatment
  • Thyroxine 100-150ug daily.
  • Aim to normalize sTSH
  • In patients with CAD start with lower dose e.g. 25ug qd.
simple non toxic goitre
Simple non-toxic goitre
  • Normal TFT’s
  • No treatment required
  • Surgery if obstructive symptoms
non thyroidal illness
Non-thyroidal illness
  • Ill patients may have low T3 and/or T4 usually with a normal sTSH
  • Psychotic patients may have elevated T3 and/or T4.
thyroid nodule
Thyroid Nodule
  • FNA
  • Benign no further intervention
  • Malignant or suspicious– papillary or follicular.
papillary cancer
Papillary Cancer
  • Controversies
    • Extent of surgery (near total thyroidectomy). Follow up with sTSH, thyroglobulin exam and US.
    • Radioactive iodine ablation for high risk tumours. Follow up with RAI scans plus the above.
follicular cancer
Follicular cancer
  • Less common than papillary
  • Total thyroidectomy (or near total).
  • Routine remnant ablation with RAI due to increased risk of metastatic disease.