Difference between revisions of "Hyperthyroidism"

(Causes)
(Clinical Features)
Line 28: Line 28:
  
 
==Clinical Features==
 
==Clinical Features==
*Constitutional
+
'''Constitutional signs:''
**Lethargy
+
*Lethargy
**Diaphoresis
+
*Diaphoresis
**Weakness
+
*Weakness
**Fever
+
*Fever
**Heat intolerance
+
*Heat intolerance
**Weight loss
+
*Weight loss
*Neuropsychiatric
+
'''Neuropsychiatric:''
**Emotional lability
+
*Emotional lability
**Fine tremor
+
*Fine tremor
**Anxiety
+
*Anxiety
**Muscle wasting
+
*Muscle wasting
**Confusion
+
*Confusion
**Hyperreflexia
+
*Hyperreflexia
**Coma
+
*Coma
**Periodic paralysis
+
*Periodic paralysis
**Psychosis  
+
*Psychosis  
*Ophthalmologic
+
'''Ophthalmologic:'''
**[[Diplopia]]
+
*[[Diplopia]]
**Lid lag
+
*Lid lag
**Eye irritation
+
*Eye irritation
**Exophthalmos
+
*Exophthalmos
**Ophthalmoplegia
+
*Ophthalmoplegia
*Endocrine
+
'''Endocrine:'''
 
**Neck fullness/tenderness (thyroid gland)
 
**Neck fullness/tenderness (thyroid gland)
*Cardiorespiratory
+
'''Cardiorespiratory:'''
**Dyspnea
+
*Dyspnea
**Widened pulse pressure
+
*Widened pulse pressure
**Palpitations
+
*Palpitations
**Systolic hypertension
+
*Systolic hypertension
**Chest pain
+
*Chest pain
**Sinus tachycardia
+
*Sinus tachycardia
**A-fib/flutter
+
*A-fib/flutter
**CHF
+
*CHF
*GI
+
'''GI:'''
**Diarrhea
+
*Diarrhea
**Hyperactive bowel sounds
+
*Hyperactive bowel sounds
*Reproductive
+
'''Reproductive:'''
**Oligomenorrhea
+
*Oligomenorrhea
**Gynecomastia
+
*Gynecomastia
**Telangiectasia
+
*Telangiectasia
*Gynecologic
+
'''Gynecologic:'''
**Menorrhagia
+
*Menorrhagia
**Sparse pubic hair
+
*Sparse pubic hair
*Hematologic
+
'''Hematologic:'''
**Anemia
+
*Anemia
**Leukocytosis
+
*Leukocytosis
*Dermatologic
+
'''Dermatologic:'''
**Hair loss
+
*Hair loss
**Pretibial myxedema
+
*Pretibial myxedema
**Warm, moist skin
+
*Warm, moist skin
**Palmar erythema
+
*Palmar erythema
**Onycholysis
+
*Onycholysis
*Apathetic hyperthyroidism (elderly patients)<ref>Rehman SU et al. Thyroid Disorders in Elderly Patients. South Med J. 2005;98(5):543-549.</ref>
+
'''Apathetic hyperthyroidism:''' (elderly patients)<ref>Rehman SU et al. Thyroid Disorders in Elderly Patients. South Med J. 2005;98(5):543-549.</ref>
**Placid apaethetic facies
+
*Placid apaethetic facies
**Depression
+
*Depression
**Lethargy
+
*Lethargy
**Muscular weakness and wasting
+
*Muscular weakness and wasting
**Excessive weight loss
+
*Excessive weight loss
**Cardiac dysrrhythmias
+
*Cardiac dysrrhythmias
**Absent or small goiter
+
*Absent or small goiter
**Absence of ocular symptoms
+
*Absence of ocular symptoms
**Agitation and confusion
+
*Agitation and confusion
  
 
==Differential Diagnosis (Tachycardia)==
 
==Differential Diagnosis (Tachycardia)==

Revision as of 00:49, 22 May 2016

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:

Clinical Features

'Constitutional signs:

  • 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

Apathetic hyperthyroidism: (elderly patients)[1]

  • Placid apaethetic facies
  • Depression
  • Lethargy
  • Muscular weakness and wasting
  • Excessive weight loss
  • Cardiac dysrrhythmias
  • Absent or small goiter
  • Absence of ocular symptoms
  • Agitation and confusion

Differential Diagnosis (Tachycardia)

Diagnosis

Workup

  • TSH (↓)
  • Free T4 (↑)
  • Free T3 (↑)

Management

  • If asymptomatic or mild symptoms, no treatment required in ED
  • If symptomatic, consider Thyroid storm

Disposition

  • If asymptomatic or no thyroid storm, discharge with outpatient follow-up.
  • Admit for significant symptoms or thyroid storm.

See Also

References

  1. Rehman SU et al. Thyroid Disorders in Elderly Patients. South Med J. 2005;98(5):543-549.