Hyperthyroidism: Difference between revisions
No edit summary
Line 1: Line 1:
==Background==
==Background==
===Precipitants===
*Hyperthyroidism: Excess circulating hormone resulting from thyroid gland hyperfunction
#infc
*Thyrotoxicosis: Excess circulating thyroid hormone originating from any cause
#surg
#trauma
#dka
#hypoglycemia
#palpation of gland
#withdrawal of meds


==DDX==
==Causes==
===Grave's Disease===
#Primary Hyperthyroidism
#exophthalmos, increased metabolism, pretib myxedema
##Graves disease (toxic diffuse goiter)
#ab stim tsh receptor
###Most common cause (85% of cases)
#decreased tsh conc
###Associated with diffuse goiter, ophthalmopathy, local dermopathy
#increased radioactive iodine uptake RAI
##Toxic multinodular goiter
#tx first with propylthiouracil or methimazole, then either albation, surg or more meds. Meds I organfication of I2
###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)


==Treatment==
==Clinical Features==
#If no CHF, hydrate with D5NS
#Constitutional
#Prograffin 3 gms qd (stops conversion and release)
##Lethargy
#Propranolol 1-2 mg IV up to 0.1 mg/kg q 1- 2 h. or 40- 80 mg q6h. for conv & betablock. not if chf or brochospasm
##Diaphoresis
#Iodide 30 ggts KI/d in divided doses or 0.5- 1.0 gm KaI in 1L ns q 12h. or sski 5 ggts q 6h. (stops release from gland)
##Weakness
#Dexamethasone 2mg q6 or hydrocortisone 100mg iv qh (stops conversion)
##Fever
#Dopamine if hypotensive
##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


==See Also==
==See Also==
[[Thyroid Storm]]
[[Thyroid Storm]]
 
[[Thyroid (General)]]
[[ Thyroid_(Main)|Thyroid (General) ]]


==Source ==
==Source ==
6/06 MISTRY
Tintinalli


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

Revision as of 02:22, 28 September 2011

Background

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

Causes

  1. Primary Hyperthyroidism
    1. Graves disease (toxic diffuse goiter)
      1. Most common cause (85% of cases)
      2. Associated with diffuse goiter, ophthalmopathy, local dermopathy
    2. Toxic multinodular goiter
      1. 2nd most common cause
    3. Toxic nodular (adenoma) goiter
      1. Enlarged thyroid gland w/ small nodules that overproduce thyroid hormone
  2. Secondary Hyperthyroidism
    1. Thyrotropin-secreting pituitary adenoma
    2. Thyroiditis
    3. Hashimoto thyroiditis
      1. Initially gland is overactive (hyperthyroidism state) followed by hypothyroidism
    4. Subacute painful thyroiditis (de Quervain thyroiditis)
    5. Subacute painless thyroiditis
    6. Radiation thyroiditis
  3. Other causes
    1. Metastatic thyroid cancer
    2. Iodine-induced thyrotoxicosis
    3. Amiodarone (contains iodine)

Clinical Features

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

See Also

Thyroid Storm Thyroid (General)

Source

Tintinalli

Retrieved from "https://www.wikem.org/w/index.php?title=Hyperthyroidism&oldid=5924"