Excess thyroid hormones in the blood result in thyrotoxicosis. The patient is in a high metabolic state. If left untreated, significant weight loss and cardiac complications, including heart failure, may occur.

COMMON CAUSES

• Toxic multi-nodular goitre
• Grave’s disease

SYMPTOMS

• Weight loss despite increased appetite
• Excessive sweating
• Heat intolerance
• Tremors
• Nervousness and irritability
• Menstrual irregularity.

SIGNS

• Staring or protruding eyes
• Tremors
• Moist palms
• Rapid pulse rate which may be irregular
• Heart failure
• Goitre often present but not always
• Smooth and diffuse goitre in Grave’s disease
• Irregular goitre in toxic multi-nodular goitre.

INVESTIGATIONS

Thyroid function tests are best carried out and interpreted at the Regional and Teaching Hospital level. Refer patients for assessment and treatment.

TREATMENT

Therapeutic objective

Treatment is aimed at reducing the thyroid hormone levels. This may be achieved either by anti-thyroid drugs, radio-iodine therapy or partial thyroidectomy. These treatments are best reserved for specialists. Early patient referral is important.

Non-Pharmacological Treatment

Addition of extra iodine to the diet (e.g. as in iodated salt) IS NOT the recommended treatment.

Pharmacological Treatment

Propranolol, oral, 10-40 mg 3 times daily, helps to reduce many of the symptoms of thyrotoxicosis and may be started prior to referral. Propranolol is contraindicated in asthmatics.

REFER

Refer all cases to specialists in a Regional or Teaching Hospital for investigations and management.