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Pathology
Increased T3 and/or T4 (usually both) due to excess production causing increased basal metabolic rate and multiple end-organ effects
Aetiology
Primary: Autonomous thyroid in multinodular goitre or autoimmune
hyperthyroidism (Graves’ Disease)
Secondary: Thyrotroph pituitary tumour, thyroiditis from drugs (e.g.
amiodarone), infections, post-partum, radiation, inappropriate use
of thyroxine medications
Signs
Fine tremor, tachycardia, warm moist skin, palmar erythema, hair loss, muscle wasting/ weakness, brisk reflexes, signs of congestive cardiac failure
Graves’ Disease: May have neck swelling and eye signs, proximal myopathy,
pre-tibial myxoedema, thyroid acropachy
Eye Signs: Exophthalmos, proptosis, ophthalmoplegia
Symptoms
Anxiety, hyperactivity, sweating, heat intolerance, palpitations, weakness, weight loss, increased stool frequency, pruritus, oligo/amenorrhoea
Investigations
Bloods: Thyroid function tests (TFTs): Increased T4, Increased T3, Decreased
TSH , Antithyroid peroxidase (TPO) antibodies, TSH receptor (TRAb)
antibodies (Graves’ Disease)
Imaging: ultrasound thyroid, thyroid uptake scan
Treatment
Medical: Symptomatic treatment with beta blockers (Propranolol) and
anti-thyroid drugs (Carbimazole, Propylthiouracil)
Radiation: Radioiodine therapy
Surgery: Thyroidectomy
Prognosis
Usually good. Can cause exacerbation of pre-existing heart failure or arrhythmias
Atrial fibrillation, heart failure, osteoporosis
Key Facts
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Key References
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