Hyperthyroidism Overview Clinical Manifestation of Hyperthyroidism: • Fatigue • Weight loss • Heat intolerance • Depression, nervousness • Irritability, anxiety or agitation • Menstrual irregularities • Weakness or tremors • Palpitations • Exertional dyspnea • Hyperdefecation • Anterior neck pain • Insomnia Primary Hyperthyroidism: • Toxic multinodular goiter (Hot nodule) • Toxic uninodular goiter • Toxic diffuse goiter (Graves' disease) • Thyrotoxicosis associated with thyroiditis Secondary Hyperthyroidism: • Factitious thyrotoxicosis • T3 Toxicosis • Iodine loads • Metastatic Follicular CA • Malignancies with circulating thyroid stimulators • TSH-producing pituitary tumors • Struma Ovarii with hyperthyroidism Diagnosis: • ↓ Low TSH • ↑ Total T3 • ↑ Free T4 • Thyroid stimulating immunoglobulin (TSI) or Thyrotropin (TSH) receptor antibodies (TRAb) if Graves' disease is suspected • Thyroid scintigraphy with radioactive iodine uptake • Thyroid US: Vascularity, Nodules, Size Thyroid Storm: • Life threatening: - Tachycardia. Cardiac arrhythmia - Fever (Hyperpyrexia) - Perspiration - Diarrhea - Anxiety, agitation, psychosis - CHF - Hypotension • Labs: - ↓ TSH, ↑ FT4 and/or ↑ T3 - Mild hypercalcemia, Hyperglycemia - ↑ AST/ALT • Treatment: - Beta blocker - Thionamide - Iodine solution - Iodinated radiocontrast agent - Glucocorticoids: Reduce T4 -> T3 - Bile acid sequestrants Hyperthyroidism Physical Examination: • Moist palms • Thickening of skin: pretibial • Bulging eyes (lid retraction or proptosis), unblinking stare • Tremor • Eye irritation, peri orbital edema, diplopia, change in visual acuity • Hyperreflexia • Tachycardia • Tachypnea • Goiter (+/- bruit) • Thyroid thrill • Ophthalmoplegia • Atrial fibrillation/flutter • Abdominal tenderness Treatment: • Beta blockers • Thioamides (Methimazole and PTU) • Radioactive iodine therapy • Thyroidectomy #hyperthyroidism #causes #diagnosis #differential #endocrinology #signs #symptoms #thyroid
