Difference between revisions of "Hyperthyroidism"

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**Onycholysis
 
**Onycholysis
  
==Labs==
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==Diagnosis==
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===Workup===
 
*Decreased TSH
 
*Decreased TSH
 
*Increased free T4
 
*Increased free T4

Revision as of 04:38, 9 April 2015

Background

  • Hyperthyroidism: Excess circulating hormone resulting from thyroid gland hyperfunction
  • Thyrotoxicosis: Excess circulating thyroid hormone originating from any cause

Causes

  • Primary Hyperthyroidism
    • Graves disease (toxic diffuse goiter)
      • Most common cause (85% of cases)
      • Associated with diffuse goiter, ophthalmopathy, local dermopathy
    • Toxic multinodular goiter
      • 2nd most common cause
    • Toxic nodular (adenoma) goiter
      • Enlarged thyroid gland w/ small nodules that overproduce thyroid hormone
  • Secondary Hyperthyroidism
    • Thyrotropin-secreting pituitary adenoma
    • Thyroiditis
    • Hashimoto thyroiditis
      • Initially gland is overactive (hyperthyroidism state) followed by hypothyroidism
    • Subacute painful thyroiditis (de Quervain thyroiditis)
    • Subacute painless thyroiditis
    • Radiation thyroiditis
  • Other causes
    • Metastatic thyroid cancer
    • Iodine-induced thyrotoxicosis
    • Amiodarone (contains iodine)

Clinical Features

  • Constitutional
    • Lethargy
    • Diaphoresis
    • Weakness
    • Fever
    • Heat intolerance
    • Weight loss
  • Neuropsychiatric
    • Emotional lability
    • Fine tremor
    • Anxiety
    • Muscle wasting
    • Confusion
    • Hyperreflexia
    • Coma
    • Periodic paralysis
    • Psychosis
  • Ophthalmologic
    • Diplopia
    • Lid lag
    • Eye irritation
    • Exophthalmos
    • Ophthalmoplegia
  • Endocrine
    • Neck fullness/tenderness (thyroid gland)
  • Cardiorespiratory
    • Dyspnea
    • Widened pulse pressure
    • Palpitations
    • Systolic hypertension
    • Chest pain
    • Sinus tachycardia
    • A-fib/flutter
    • CHF
  • GI
    • Diarrhea
    • Hyperactive bowel sounds
  • Reproductive
    • Oligomenorrhea
    • Gynecomastia
    • Telangiectasia
  • Gynecologic
    • Menorrhagia
    • Sparse pubic hair
  • Hematologic
    • Anemia
    • Leukocytosis
  • Dermatologic
    • Hair loss
    • Pretibial myxedema
    • Warm, moist skin
    • Palmar erythema
    • Onycholysis

Diagnosis

Workup

  • Decreased TSH
  • Increased free T4
  • Increased free T3

Treatment

  • Beta-antagonists
  • Methimazole
  • Propylthiouracil
  • Radioactive iodine
  • Surgery

In Pregnancy

  • Propylthiouracil - 1st Trimester[1]
  • Methimazole - 2nd Trimester and on[2]

See Also

Source