Hyperthyroidism

Symptoms:

  • General – fine tremor, anxiety, irritability, emotional lability, panic attacks, heat intolerance, sweating
  • CV – palpitations
  • GI – increased appetite, diarrhea, wt loss
  • GU – menstrual dysfunction, infertility
  • Graves’ – blurring of vision, photophobia, double vision, increased lacrimation

Signs

  • General – hyperreflexia
  • CV – tachycardia, atrial fibrillation
  • Neuro – proximal muscle weakness
  • Skin – fine hair, moist warm skin, vitiligo, soft nails
  • MSK –  bone mass, hypercalcemia, muscle wasting
  • Graves’ – exophthalmos, lid retraction, lid lag, clubbing, acropachy, pretibial myxedema



 

Physical Exam

Etiology:        

  • Graves’ disease (80 – 90 %)
  • Hashimoto’s thyroiditis
  • Subacute thyroiditis
  • Toxic multinodular goiter
  • Toxic adenoma
  • Iatrogenic and factitious

Differential Diagnosis:

  • Anxiety disorder
  • Pheochromocytoma
  • Metastatic neoplasm
  • Diabetes mellitus
  • Premenopausal state

Investigations:

Bloodwork

  • TSH (low), T4 & T3 (elevated)
  • Thyroid antibodies – can use to differentiate Graves’ and toxic multinodular goiter

Imaging

  • RAIU
    • Increased uptake in overactive thyroid, decreased in thyroiditis and iatrogenic T4 ingestion
    • Uptake is homogeneous in Graves’, heterogeneous in multinodular goiter, and single focus in a hot nodule

Management

ANTITHYROID DRUGS:

  • Thionamides
    • Propylthiouracil (PTU) and Methimazole (Tapazole
      • Inhibit thyroid hormone synthesis (block thyroid peroxidase); inhibit peripheral conversion of T4 to T3
      • Most useful in young, nonpregnant patients with small glands and mild disease
      • Patients should be seen every 1 – 3 months until euthyroid, then q 3-4mo while remaining on medication
  • B-BLOCKERS – Propranolol for symptomatic control

MEDICAL ABLATION

  • Radioactive iodine – used in Graves’ when PTU or MMI fail to produce remission
  • Usually require lifelong thyroid hormone replacement

SURGICAL ABLATION:

  • Subtotal thyroidectomy

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