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

1. Symptoms of hyperthyroidism or hypothyroidism

2. Children, especially those in endemic iodine deficiency locales

3. Pregnant and lactating women

4. Elderly patients

5. Patients with excessive radiation exposure

6. 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

Hyperthyroid work-up

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