Wednesday, May 2, 2012

Graves disease

Auto immune (TSH receptor antibodies)

Goitre- diffuse

Hyperthyroidism (most common cause is Graves dx)

Ophthamopathy(only in Graves)

hyperthyroid sympoms : wt loss , tremors, heat intolerance, diarrhoea, palpitations, menstrual irregularities, bruit over goitre, may have pretibial myxedema , proximal muscle weakness (can occur in both hypo and hyper) etc.

High T3, T4, low TSH (primary hyperthyroidism)

High radioiodine uptake (same for toxic nodule)

Acute phase
  1. Propanolol or Atenolol
  2. Propylthioracil or methimazole
continue until patient is euthyroid

Definitive treatment
  • Radioactive iodine (kill the thyroid)
continue until patient is hypothyroid, then
  • thyroid replacement therapy

proptosis may worsen with tmt
Agranulocytosis may occur with PTU or Methimazole, monitor wbc.
if patient c/o fever, sorethroat etc while on tmt, stop meds and check wbc count
The agranulocytosis is reversible

In pregnancy,
Acute phase: low dose propanolol + low dose PTU. Do not use Methimazole in pregnancy
Definitive: Surgery in 2nd trimester. Do not use radio iodine in pregnancy

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