Hyperthyroidism

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<Index>

 

Definition

-  Overproduction of throid hormones T4 &/or T3

 

Features

-  Female > male

-  Associted w myasthenia gravis

-  Typically T4 thyrotoxicosis

-  T3 thyrotoxicosis less common

 

Causes

-  Graves disease 70-80%

-  Thyrotoxic multinodular goiter

-  Thyroid Ca

-  Thyroid adenoma (benign nodule)

-  Thyroiditis

-  Hashimotos thyroiditis

-  Subacute thyroiditis

-  Postpartum thyroiditis

-  Iodine induced thyrotoxicosis

-  Amiodarone (Class III anti-arythmic)

 

Associated S/S

-  Thyrotoxicosis (Thyroid Storm)

-  Goitre

-  Nodule

-  Cardiac

-  Tachycardia, AF

-  Palpitations

-  Dilated cardiomyopathy

-  CCF

-  Cardiomegaly

-  GIT

-  Hypermobility

-  Diarrhoea

-  Malabsorption

-  Stertorrhoea

-  Polyphagia

-  Weight loss

-  Opthal

-  Dalrymple sign (lid lag)

-  von Graefe’s sign (lid retraction)

-  SNS

-  Soft warm flushed skin

-  Sweating

-  Heat intolerance

-  Emotional liability

-  Hyperactivity

-  Insomnia

-  Anxiety, Depression

-  Osteoporosis

-  MSK

-  Proximal myopathy

-  Tremor

-  Hyper-reflexia

-  Hair loss

-  Menstrual irregularities

 

Ix

- TFTs

-  TSH

-  Decreased: 1o

-  Normal: hyperthyroidism unlikely

-  Elevated: 2o (rare)

-  FT4

-  Normal w increased TSH: ? T3 thyrotoxicosis or subclinical hyperthyroidism

-  Elevated: T4 thyrotoxicosis

-  T3

-  Normal w increased TSH: T4 thyrotoxicosis or subclinical hyperthyroidism

-  Elevated: T3 thyrotoxicosis

- TSH Receptor Ab: Graves disease

- TPO Ab: Hashimotos thyroiditis

- Thyroid Scan

- Thyroid US

 

Mx

- Thyroid Diesease in Pregnancy