Difference between revisions of "Hyperthyroidism"

(Labs)
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**Palmar erythema
 
**Palmar erythema
 
**Onycholysis
 
**Onycholysis
 +
 +
==Differential Diagnosis==
  
 
==Diagnosis==
 
==Diagnosis==
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*Increased free T3
 
*Increased free T3
  
==Treatment==
+
==Management==
 
*Beta-antagonists
 
*Beta-antagonists
 
*Methimazole
 
*Methimazole
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===In Pregnancy===
 
===In Pregnancy===
*Propylthiouracil - 1st Trimester<ref>http://www.womenshealth.gov/publications/our-publications/fact-sheet/graves-disease.html*f</ref>
+
*Propylthiouracil - 1st Trimester<ref name="WH">http://www.womenshealth.gov/publications/our-publications/fact-sheet/graves-disease.html*f</ref>
*Methimazole - 2nd Trimester and on<ref>http://www.womenshealth.gov/publications/our-publications/fact-sheet/graves-disease.html*f</ref>
+
*Methimazole - 2nd Trimester and on<ref name="WH" />
 +
 
 +
==Disposition==
 +
 
  
 
==See Also==
 
==See Also==
*[[Thyroid Storm]]
+
*[[Thyroid storm]]
*[[Thyroid (General)]]
+
*[[Thyroid (Main)]]
  
==Source ==
+
==References==
*Tintinalli
+
<references/>
*http://www.womenshealth.gov/publications/our-publications/fact-sheet/graves-disease.html*f
 
<references/>  
 
  
 
[[Category:Endo]]
 
[[Category:Endo]]

Revision as of 03:14, 11 August 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

Differential Diagnosis

Diagnosis

Workup

  • Decreased TSH
  • Increased free T4
  • Increased free T3

Management

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

In Pregnancy

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

Disposition

See Also

References