Hyperthyroidism Exam Questions with Verified Solutions Latest Update 2025 (Already Passed)
Hyperthyroidism (Grave's Disease) - Answers - autoimmune
- antibodies to TSH receptor stimulate gland
- increased production of thyroid hormones
- 2% women, 0.2% men
Features of Hyperthyroidism - Answers - Anxious
- Palpitations
- Tremor
- Weight loss
- Tachy
- Goitre--> specific: not universal
- Prefers cold weather
- Warm, moist skin
**many nonspecific symptoms (thus differential= cancer)
TFTs for hyper - Answers - LOW TSH levels (neg feedback)
- HIGH free (unbound) T4 levels
Treatment options for hyper (3) - Answers 1. Drug therapy- therapy&adjuvant treatment
2. Radioactive iodine
3. Surgery
**none are ideal (involve patient in choice if possible)
Drug therapy for hyper - Answers - carbimazole (active metabolite, methimazole) & propylthiouracil
- interferes with thyroid hormone synthesis
- preferred for children, pregnancy, breast feeding, uncomplicated disease in young adults
Carbimazole - Answers - first choice
- start with 15-40mg daily (depending on symptom severity)
, - maintain until TFTs normal (4-8weeks)
- maintenance for 12-18mos
--> decrease by 25-30% monthly, until 5-15mg
- longer term treatment may be required if relapse
Block and Replace Therapy - Answers - Carbimazole 40-60mg & 50-100mcg thyroxine
- Carbimazole for approx. 4-8 weeks before start thyroxine
- makes pt TEMPORARILY hypo
- 6-12mos usually; up to 18mos
- thyroid gland returns to normal function when stop treatment
- relapse may occure
- not in pregnancy (carbimazole crosses placenta--> baby can be impaired)
Propylthiouracil - Answers - 200-400mg daily initially, in divided doses
- 50mg tid maintenance
- pregnancy & breast feeding (? slightly safer)
- intolerant of carbimazole (rash, agranulocytosis)
Drug-induced agranulocytosis - Answers - both can cause bone marrow suppression
- decreased WBC-> infection
- 0.3-0.5%= abrupt onset & not dose related
- CSM warning BNF
CSM warning from BNF for carbimazole - Answers - must recog bone marrow suppression induced by
carbimazole, need to stop treatment promptly
- patient should be asked to report symptoms and signs suggestive of infection (esp sore throat)
- WCC performed if any clinical evidence of infection
- carbimazole should be stopped if any clinical/lab evidence of neutropenia
Patient Counselling for hyper - Answers - carbimazole as single daily dose
- duration of treatment
Hyperthyroidism (Grave's Disease) - Answers - autoimmune
- antibodies to TSH receptor stimulate gland
- increased production of thyroid hormones
- 2% women, 0.2% men
Features of Hyperthyroidism - Answers - Anxious
- Palpitations
- Tremor
- Weight loss
- Tachy
- Goitre--> specific: not universal
- Prefers cold weather
- Warm, moist skin
**many nonspecific symptoms (thus differential= cancer)
TFTs for hyper - Answers - LOW TSH levels (neg feedback)
- HIGH free (unbound) T4 levels
Treatment options for hyper (3) - Answers 1. Drug therapy- therapy&adjuvant treatment
2. Radioactive iodine
3. Surgery
**none are ideal (involve patient in choice if possible)
Drug therapy for hyper - Answers - carbimazole (active metabolite, methimazole) & propylthiouracil
- interferes with thyroid hormone synthesis
- preferred for children, pregnancy, breast feeding, uncomplicated disease in young adults
Carbimazole - Answers - first choice
- start with 15-40mg daily (depending on symptom severity)
, - maintain until TFTs normal (4-8weeks)
- maintenance for 12-18mos
--> decrease by 25-30% monthly, until 5-15mg
- longer term treatment may be required if relapse
Block and Replace Therapy - Answers - Carbimazole 40-60mg & 50-100mcg thyroxine
- Carbimazole for approx. 4-8 weeks before start thyroxine
- makes pt TEMPORARILY hypo
- 6-12mos usually; up to 18mos
- thyroid gland returns to normal function when stop treatment
- relapse may occure
- not in pregnancy (carbimazole crosses placenta--> baby can be impaired)
Propylthiouracil - Answers - 200-400mg daily initially, in divided doses
- 50mg tid maintenance
- pregnancy & breast feeding (? slightly safer)
- intolerant of carbimazole (rash, agranulocytosis)
Drug-induced agranulocytosis - Answers - both can cause bone marrow suppression
- decreased WBC-> infection
- 0.3-0.5%= abrupt onset & not dose related
- CSM warning BNF
CSM warning from BNF for carbimazole - Answers - must recog bone marrow suppression induced by
carbimazole, need to stop treatment promptly
- patient should be asked to report symptoms and signs suggestive of infection (esp sore throat)
- WCC performed if any clinical evidence of infection
- carbimazole should be stopped if any clinical/lab evidence of neutropenia
Patient Counselling for hyper - Answers - carbimazole as single daily dose
- duration of treatment
