Hyperactivity, irritability Heat intolerance/sweating Palpitations Fatigue, weakness Weight loss but increased appetite DIarrhoea Polyuria Oligomenorrhoea Loss of libido [source: Harrisons - descending order of frequency]
What are the most frequent signs of hyperthyroidism?
Tachycardia/AF Tremor Goitre Warm/moist skin Muscle weakness, proximal myopathy Lid retraction/lid lag Gynaecomastia [source: Harrisons - descending order of frequency]
What are the INITIAL investigations you would perform in a patient you suspect might be hyperthyroid from history/exam?
TSH If normal, not thyroid dysfunction If TSH low, free T3/ free T4
Your patient has a low TSH, high fT3/fT4. What antibodies should you request? Why?
TSH-receptor antibody (TRAb) - Graves Anti-thyroperoxidase (anti-TPO) - Hashimoto's, Graves, nodular goitre, cancer Thyroglobulin antibodies (less useful - mostly used in monitoring for cancer recurrence post-thyroidectomy)
(Don't just write "thyroid antibodies" on a path slip! Never works!)
When would you order an ultrasound in a hyperthyroid patient?
When you're worried about cancer (eg rapid growth, asymmetrical, focal firmness, goitre but normal TSH, negative antibodies) Also consider FNA if worried about cancer (can write "USS +/- FNA" on the request and let radiologist decide)
If the TSH is subnormal, what would be your imaging of choice?