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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
- 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
- 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
