Hyperthyroidism

Revision as of 00:42, 22 May 2016 by Ostermayer (talk | contribs) (Causes)

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
    • 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.