Hyperthyroidism

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Hyperthyroidism

• due to excess T₃ and T₄
• rarely due to excess TSH

Causes

• Grave's Disease
• Solitary toxic nodule / functioning adenoma
  • rare
• Toxic multinodular goitre
  • older patients

Presentation

• Weight Loss
• Palpitations
• Anxiety
• Shortness of breath

History

• may have had symptoms for some time
• goitre
• general
  • heat intolerance
  • change in appearance
• GI
  • diarrhoea
• CVS / RS
  • palpitations
  • shortness of breath on exertion
• GU
  • amenorrhoea

PMH

• other autoimmune conditions

FHx

• thyroid dysfunction
• other autoimmune conditions

DHx

• beta-blockers
• carbimazole

ROS

SHx

Examination

General

• thin
• nervous
• fidgety

Hands

• sweaty palms
• tremor
• palmar erythema
• thyroid acropachy

Neck

• goitre
• bruit

Face

• exophthalmos
• Lid retraction
• lid lag
• Eyes

CVS

• Tachycardia
• Atrial Fibrillation
• bounding pulse
• Heart Failure
  • esp. in elderly

CNS

• proximal muscle weakness

Other

• Pretibial Myxoedema

Investigations

• Thyroid function tests
• USS / CT goitre
• Radioisotope studies

Treatment

• carbimazole
  • risk of agranulocytosis
• propranolol
• radioactive iodine
• surgery
  • Indications

Complications

• thyrotoxic crisis

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