Hyperthyroidism:

Surgical Management of Hyperthyroid:
- Grave's disease
- Toxic nodular goitre (single or multiple)
- Amiodarone-induced thyrotoxicosis

Preop preparation of patients required to normalize T3/T4 using thioamides.  In the past super-saturated potassium iodide or Lugol's solution used to resture thyroid function and decrease thyroid vascularity but does so only temporarily.

Medical management:
- Thioamides (propylthiouracil, methimazole): decrease thyroid hormone synthesis, takes several weeks to take effect.  Effective in 90% of patients, but relapses occur in ~80% of pts.  Complications: Agranulocytosis rare (0.5%)
- Radioactive iodine 131-I, highly effective in Grave's disease (90%), pt becomes hypothyroid.  Can worsen thyrotoxicosis
- 131-I contraindicated during pregnancy or in lactating mothers

Pemberton's Sign:
- facial plethora, inspiratory stridor, venous congestion when arms raised above head
- sign of jugular venous compression (thoracic outlet obstruction can be from large goiter)