26. Hyperthyrodisim, Thyrotoxicosis Flashcards
(14 cards)
What is hyperthyroidism?
Hyperthyroidism refers to the symptoms caused by excessive circulating thyroid hormones T3/T4, typically caused by thyroid gland hyperactivity.
What are the causes of hyperthyroidism?
1) Hyperfunctioning thyroid gland: Graves disease, toxic multinodular goiter, toxic adenoma, TSH producing pituitary adenoma, hashitoxicosis.
Always rem graves dis has positive TSI and high radioactive iodine uptake in comparison to hashitoxicosis
2) Destruction of the thyroid gland: thyroiditis, Hashimoto thyroiditis.
3) Ectopic hormone production: struma ovarii, metastatic follicular thyroid carcinoma.
What is the pathophysiology of hyperthyroidism?
Disorders of the thyroid gland lead to excess production of T3/T4, resulting in a compensatory decrease of TSH.
What are the general symptoms of hyperthyroidism?
Heat intolerance, excessive sweating, weight loss despite increased appetite, weakness, fatigue, and hyperreflexia.
What cardiovascular symptoms are associated with hyperthyroidism?
Tachycardia, palpitation, hypertension.
What musculoskeletal symptoms are associated with hyperthyroidism?
Fine tremors, myopathy, osteoporosis, eyelid retraction (staring look), goiter (diffuse, smooth, non-tender).
What endocrine symptoms are associated with hyperthyroidism?
Oligo/amenorrhea, anovulatory infertility in females; gynecomastia, decreased libido, erectile dysfunction in males.
What neuro symptoms are associated with hyperthyroidism?
Anxiety, agitation, depression, insomnia.
What is the initial test for diagnosing hyperthyroidism?
Serum TSH level (low) is the initial test of choice. If TSH is normal or high, hyperthyroidism is unlikely.
What thyroid hormone levels indicate hyperthyroidism?
T4 elevated. Test T3 if TSH is low and T4 is normal.
What does thyroid radioiodine uptake indicate?
High uptake in Graves’ disease and nodular disease vs. low uptake in thyroid destruction, iodine excess, and extrathyroidal sources of thyroid hormone.
What is the treatment for Graves disease?
Antithyroid drugs or radioiodine; subtotal thyroidectomy is rarely indicated. Main antithyroid drugs are methimazole or carbimazole (10–20 mg 2x a day initially, titrated to 2.5–10mg/d).
What is symptomatic therapy for thyrotoxicosis?
Beta blockers improve tachycardia, hypertension, tremor, and neuropsychiatric symptoms. In high doses, propranolol decreases the peripheral conversion of T4 to T3.
What is a thyroid storm?
An acute exacerbation of hyperthyroidism that results in a life-threatening hypermetabolic state. Treatment includes monitoring, fluids and electrolytes substitution, treating hyperthermia, and starting beta-blockers like propranolol.
