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)

Tmt:
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


Note:
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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