Hyperthyroidism: Difference between revisions

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===Causes===
===Causes===
#Primary Hyperthyroidism  
*Primary Hyperthyroidism  
##Graves disease (toxic diffuse goiter)
**Graves disease (toxic diffuse goiter)
###Most common cause (85% of cases)
***Most common cause (85% of cases)
###Associated with diffuse goiter, ophthalmopathy, local dermopathy
***Associated with diffuse goiter, ophthalmopathy, local dermopathy
##Toxic multinodular goiter
**Toxic multinodular goiter
###2nd most common cause
***2nd most common cause
##Toxic nodular (adenoma) goiter
**Toxic nodular (adenoma) goiter
###Enlarged thyroid gland w/ small nodules that overproduce thyroid hormone
***Enlarged thyroid gland w/ small nodules that overproduce thyroid hormone
#Secondary Hyperthyroidism  
*Secondary Hyperthyroidism  
##Thyrotropin-secreting pituitary adenoma
**Thyrotropin-secreting pituitary adenoma
##Thyroiditis
**Thyroiditis
##Hashimoto thyroiditis
**Hashimoto thyroiditis
###Initially gland is overactive (hyperthyroidism state) followed by hypothyroidism
***Initially gland is overactive (hyperthyroidism state) followed by hypothyroidism
##Subacute painful thyroiditis (de Quervain thyroiditis)  
**Subacute painful thyroiditis (de Quervain thyroiditis)  
##Subacute painless thyroiditis  
**Subacute painless thyroiditis  
##Radiation thyroiditis  
**Radiation thyroiditis  
#Other causes
*Other causes
##Metastatic thyroid cancer
**Metastatic thyroid cancer
##Iodine-induced thyrotoxicosis
**Iodine-induced thyrotoxicosis
##Amiodarone (contains iodine)
**Amiodarone (contains iodine)


==Clinical Features==
==Clinical Features==
#Constitutional
*Constitutional
##Lethargy
**Lethargy
##Diaphoresis
**Diaphoresis
##Weakness
**Weakness
##Fever
**Fever
##Heat intolerance
**Heat intolerance
##Weight loss
**Weight loss
#Neuropsychiatric
*Neuropsychiatric
##Emotional lability
**Emotional lability
##Fine tremor
**Fine tremor
##Anxiety
**Anxiety
##Muscle wasting
**Muscle wasting
##Confusion
**Confusion
##Hyperreflexia
**Hyperreflexia
##Coma
**Coma
##Periodic paralysis
**Periodic paralysis
##Psychosis  
**Psychosis  
#Ophthalmologic
*Ophthalmologic
##[[Diplopia]]
**[[Diplopia]]
##Lid lag
**Lid lag
##Eye irritation
**Eye irritation
##Exophthalmos
**Exophthalmos
##Ophthalmoplegia
**Ophthalmoplegia
#Endocrine
*Endocrine
##Neck fullness/tenderness (thyroid gland)
**Neck fullness/tenderness (thyroid gland)
#Cardiorespiratory
*Cardiorespiratory
##Dyspnea
**Dyspnea
##Widened pulse pressure
**Widened pulse pressure
##Palpitations
**Palpitations
##Systolic hypertension
**Systolic hypertension
##Chest pain
**Chest pain
##Sinus tachycardia
**Sinus tachycardia
##A-fib/flutter
**A-fib/flutter
##CHF
**CHF
#GI
*GI
##Diarrhea
**Diarrhea
##Hyperactive bowel sounds
**Hyperactive bowel sounds
#Reproductive
*Reproductive
##Oligomenorrhea
**Oligomenorrhea
##Gynecomastia
**Gynecomastia
##Telangiectasia
**Telangiectasia
#Gynecologic
*Gynecologic
##Menorrhagia
**Menorrhagia
##Sparse pubic hair
**Sparse pubic hair
#Hematologic
*Hematologic
##Anemia
**Anemia
##Leukocytosis
**Leukocytosis
#Dermatologic
*Dermatologic
##Hair loss
**Hair loss
##Pretibial myxedema
**Pretibial myxedema
##Warm, moist skin
**Warm, moist skin
##Palmar erythema
**Palmar erythema
##Onycholysis
**Onycholysis


==Labs==
==Labs==
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===In Pregnancy===
===In Pregnancy===
*Propylthiouracil - 1st Trimester<ref>http://www.womenshealth.gov/publications/our-publications/fact-sheet/graves-disease.html#f</ref>
*Propylthiouracil - 1st Trimester<ref>http://www.womenshealth.gov/publications/our-publications/fact-sheet/graves-disease.html*f</ref>
*Methimazole - 2nd Trimester and on<ref>http://www.womenshealth.gov/publications/our-publications/fact-sheet/graves-disease.html#f</ref>
*Methimazole - 2nd Trimester and on<ref>http://www.womenshealth.gov/publications/our-publications/fact-sheet/graves-disease.html*f</ref>


==See Also==
==See Also==
Line 102: Line 102:
==Source ==
==Source ==
*Tintinalli
*Tintinalli
*http://www.womenshealth.gov/publications/our-publications/fact-sheet/graves-disease.html#f
*http://www.womenshealth.gov/publications/our-publications/fact-sheet/graves-disease.html*f
<references/>  
<references/>  


[[Category:Endo]]
[[Category:Endo]]

Revision as of 04:37, 9 April 2015

Background

  • Hyperthyroidism: Excess circulating hormone resulting from thyroid gland hyperfunction
  • Thyrotoxicosis: Excess circulating thyroid hormone originating from any cause

Causes

  • Primary Hyperthyroidism
    • Graves disease (toxic diffuse goiter)
      • Most common cause (85% of cases)
      • Associated with diffuse goiter, ophthalmopathy, local dermopathy
    • Toxic multinodular goiter
      • 2nd most common cause
    • Toxic nodular (adenoma) goiter
      • Enlarged thyroid gland w/ small nodules that overproduce thyroid hormone
  • Secondary Hyperthyroidism
    • Thyrotropin-secreting pituitary adenoma
    • Thyroiditis
    • Hashimoto thyroiditis
      • Initially gland is overactive (hyperthyroidism state) followed by hypothyroidism
    • Subacute painful thyroiditis (de Quervain thyroiditis)
    • Subacute painless thyroiditis
    • Radiation thyroiditis
  • Other causes
    • Metastatic thyroid cancer
    • Iodine-induced thyrotoxicosis
    • Amiodarone (contains iodine)

Clinical Features

  • Constitutional
    • Lethargy
    • Diaphoresis
    • Weakness
    • Fever
    • Heat intolerance
    • Weight loss
  • Neuropsychiatric
    • Emotional lability
    • Fine tremor
    • Anxiety
    • Muscle wasting
    • Confusion
    • Hyperreflexia
    • Coma
    • Periodic paralysis
    • Psychosis
  • Ophthalmologic
    • Diplopia
    • Lid lag
    • Eye irritation
    • Exophthalmos
    • Ophthalmoplegia
  • Endocrine
    • Neck fullness/tenderness (thyroid gland)
  • Cardiorespiratory
    • Dyspnea
    • Widened pulse pressure
    • Palpitations
    • Systolic hypertension
    • Chest pain
    • Sinus tachycardia
    • A-fib/flutter
    • CHF
  • GI
    • Diarrhea
    • Hyperactive bowel sounds
  • Reproductive
    • Oligomenorrhea
    • Gynecomastia
    • Telangiectasia
  • Gynecologic
    • Menorrhagia
    • Sparse pubic hair
  • Hematologic
    • Anemia
    • Leukocytosis
  • Dermatologic
    • Hair loss
    • Pretibial myxedema
    • Warm, moist skin
    • Palmar erythema
    • Onycholysis

Labs

  • Decreased TSH
  • Increased free T4
  • Increased free T3

Treatment

  • Beta-antagonists
  • Methimazole
  • Propylthiouracil
  • Radioactive iodine
  • Surgery

In Pregnancy

  • Propylthiouracil - 1st Trimester[1]
  • Methimazole - 2nd Trimester and on[2]

See Also

Source

  1. ↑ http://www.womenshealth.gov/publications/our-publications/fact-sheet/graves-disease.html*f
  2. ↑ http://www.womenshealth.gov/publications/our-publications/fact-sheet/graves-disease.html*f
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