Clinical state from excess thyroid hormone, most often Graves' disease.
Causes
- • Graves' (autoimmune TRAb)
- • Toxic multinodular goitre
- • Toxic adenoma
- • Thyroiditis
- • Iodine, amiodarone
Clinical features
- • Heat intolerance, sweating
- • Weight loss, palpitations
- • Tremor, anxiety
- • Diarrhoea, oligomenorrhoea
Examination
- • Goitre ± bruit
- • Tremor, warm peripheries
- • Lid lag, ophthalmopathy (Graves')
- • AF, hyperreflexia
Investigations
- • TSH ↓, fT4/fT3 ↑
- • TRAb, anti-TPO
- • Thyroid USS, uptake scan if cause unclear
Management
- • β-blocker symptom control
- • Carbimazole (block-and-replace or titration)
- • Definitive: radioiodine or thyroidectomy
- • Treat thyroid storm: PTU, propranolol, hydrocortisone, Lugol's iodine
Complications
- • Thyroid storm
- • AF, HF
- • Osteoporosis
- • Ophthalmopathy
Clinical pearls
- • Carbimazole agranulocytosis — warn re sore throat
- • PTU preferred in 1st trimester, carbimazole after
Related in WardRound
Educational — verify locally.
