Hyperthyroidism
Thyrotoxicosis
Thyroid Disease
Hyperthyroid
Graves disease
Toxic Thyroid adenoma
Toxic Multinodular goiter
TSH-producing pituitary adenoma
hCG-mediated TSH suppression
Hyperemesis gravidume
Functional thyroid met
Nonhyperthyroid
Painful subacute thyroiditis
Painless thyroiditis (including post party)
Iatrogenic
Drugs
Acute thyroiditis
Radiation thyroiditis
Food contaminated with thyroid hormone
Symptoms
-
common symptoms include
- fatigue, nervousness, anxiety, poor concentration
- palpitations
- heat intolerance, increased sweating
- weight loss despite increased appetite
- tremor, muscle weakness
- neck swelling
- oligomenorrhea or infertility in women, decreased libido in men
- depression (=apathetic hyperthyroidism), is more common in older adults
- Graves ophthalmopathy, such as eye irritation, pain, or eyelid swelling (see Graves disease for additional information)
Physical Exam Findings
Vitals: Tachycardic, HTN, low Wt
Skin: Warm, moist skin
HEENT: Exopthalmos
Neck: Goiter?, Symmetry?, Nodules? bruits?
CVS: ?AF ?HF (high JVP, peripheral edema, S3)
Resp: ?HF
Whom a Goiter Disease Should Be Considered
-
Symptoms of hyperthyroidism or hypothyroidism
-
Children, especially those in endemic iodine deficiency locales
-
Pregnant and lactating women
-
Elderly patients
-
Patients with excessive radiation exposure
-
Patients with Down syndrome
Assessing Grave's Opthalmopathy
-
1 point each assigned for
- swelling of conjunctiva
- swelling of eyelids
- swelling of caruncle or plica
- redness of conjunctiva
- redness of eyelids
- pain on attempted upward or downward gaze
- spontaneous retrobulbar pain
- CAS score < 3 classified as inactive Graves ophthalmopathy
- CAS score ≥ 3 classified as active Graves ophthalmopathy
Investigations
TSH
Free T4/Free T3
Thyroid Uptake scan
Thyroglobulin
TSH R-Ab
Treatment
Treat all symptomatic thyrotoxicosis
Treating Graves Disease
Treating Toxic Multinodular Goiter or Adenoma
Thyroid Storm
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By Seana Nelson
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