Paper II — 2022 July (Supplementary) (2019 Scheme) — Q1
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Paper II
2022 July (Supplementary) (2019 Scheme) · 100 marks · 180 min
Question
A 30-year-old female patient with complaints of restlessness, excessive sweating visits a
physician. On investigation, patient was having high levels of free T3/T4 and very low TSH
levels. A diagnosis of hyperthyroidism was made.
(
(a) Classify the drugs used for the above condition. Outline the line of management.
( 3 mark(s)
(c) Discuss the pharmacological management of thyroid storm. 4 mark(s)
Q110 marksEssays
Answer
a) Classification and line of management
Group
Examples
Thioamides
Carbimazole, Methimazole, Propylthiouracil
Iodides
Lugol’s iodine
Radioactive iodine
I-131
Beta-blockers
Propranolol (symptomatic adjunct)
First-line management for Graves’ disease is typically a thioamide (Carbimazole), with a beta-blocker added for rapid symptomatic relief of adrenergic symptoms; radioactive iodine or surgery are considered for definitive treatment, relapse, or contraindication to medical therapy.
b) Radioactive Iodine
I-131 is taken up by the thyroid via the sodium-iodide symporter, concentrating in thyroid tissue, where beta-particle emission causes localized cellular destruction over weeks. Used for definitive treatment of Graves’ disease and toxic nodular goitre. The expected outcome is hypothyroidism, requiring lifelong levothyroxine replacement. Absolutely contraindicated in pregnancy.
c) Pharmacological management of thyroid storm
Propranolol (high-dose) — rapid control of adrenergic symptoms (tachycardia, tremor, agitation); also blocks peripheral T4-to-T3 conversion at high doses.
Propylthiouracil (preferred over other thioamides here) — blocks new hormone synthesis and additionally inhibits peripheral T4-to-T3 conversion.
Iodide solution (given after starting the thioamide, to avoid providing substrate for further hormone synthesis) — Wolff-Chaikoff effect, rapidly blocks hormone release.
Corticosteroids (Hydrocortisone) — inhibit peripheral T4-to-T3 conversion and cover possible relative adrenal insufficiency.
Supportive care: cooling measures, IV fluids, treatment of the precipitating cause.
