Thyroid 

Most common causes of hyperthyroidism are:

  1. diffuse toxic goitre (graves disease)
  2. Toxic multinodular goitre (plummer disease)
  3. Toxic adenoma

Graves Disease

  • Raised T3/T4, reduced TSH
  • High thyroid autoantibodies (particularly TSH receptor antibody)
  • Palmar erythema
  • Conjunctival oedema
  • Exopthalmus
  • Pretibial myxoedema
  • Thyroid bruit
  • Diffuse goitre
  • Treatment options:
  • – anti thyroid drugs
  • – radio iodine
  • – surgery

DeQuervain’s Thyroiditis

  • Short history
  • Painful goitre (can be small)
  • Unwell / neck pain / possible weight loss
  • Self limiting
  • Responds to NSAIDs and steroids

Multinodular Goitre 

  • Can be Thyrotoxic (a “toxic multinodular goitre (MNG)”)- eg tachy / weight loss / palpitations / lid lag / anxiety
  • Or can be asymptomatic
  • Or can present with symptoms from pressure – dysphasia / hoarseness/ dyspnoea
  • Enlarged lobulated goitre 

Toxic Nodule

  • single nodule of thyroid tissue releasing too much thyroxine
  • patient can be thyrotoxic

Hashimoto’s thyroiditis

  • Causes hypothyroidism
  • Autoimmune condition associated with auto antibodies
  • Associated with other auto immune conditions

Subacute thyroiditis

  • Associated with viral infections
  • Transient elevation in Thyroid hormones
  • ESR elevated

 

Drug induced thyrotoxicosis

  • Amiodarone can cause almost any kind of thyroid level abnormality