Hyperthyroidism Overview



Clinical Manifestation of Hyperthyroidism:

 • Fatigue

 • Weight loss

 • Heat intolerance

 • Depression, nervousness

 • Irritability, anxiety or agitation

 • Menstrual irregularities

 • Weakness or tremors

 • Palpitations

 • Exertional dyspnea

 • Hyperdefecation

 • Anterior neck pain

 • Insomnia



Primary Hyperthyroidism:

 • Toxic multinodular goiter (Hot nodule)

 • Toxic uninodular goiter

 • Toxic diffuse goiter (Graves' disease)

 • Thyrotoxicosis associated with thyroiditis



Secondary Hyperthyroidism:

 • Factitious thyrotoxicosis

 • T3 Toxicosis

 • Iodine loads

 • Metastatic Follicular CA

 • Malignancies with circulating thyroid stimulators

 • TSH-producing pituitary tumors

 • Struma Ovarii with hyperthyroidism



Diagnosis:

 • ↓ Low TSH

 • ↑ Total T3

 • ↑ Free T4

 • Thyroid stimulating immunoglobulin (TSI) or Thyrotropin (TSH) receptor antibodies (TRAb) if Graves' disease is suspected

 • Thyroid scintigraphy with radioactive iodine uptake

 • Thyroid US: Vascularity, Nodules, Size



Thyroid Storm:

 • Life threatening:

	- Tachycardia. Cardiac arrhythmia

	- Fever (Hyperpyrexia)

	- Perspiration

	- Diarrhea

	- Anxiety, agitation, psychosis

	- CHF

	- Hypotension

 • Labs:

	- ↓ TSH, ↑ FT4 and/or ↑ T3

	- Mild hypercalcemia, Hyperglycemia

	- ↑ AST/ALT

 • Treatment:

	- Beta blocker

	- Thionamide

	- Iodine solution

	- Iodinated radiocontrast agent

	- Glucocorticoids: Reduce T4 -> T3

	- Bile acid sequestrants



Hyperthyroidism Physical Examination:

 • Moist palms

 • Thickening of skin: pretibial

 • Bulging eyes (lid retraction or proptosis), unblinking stare

 • Tremor

 • Eye irritation, peri orbital edema, diplopia, change in visual acuity

 • Hyperreflexia

 • Tachycardia

 • Tachypnea

 • Goiter (+/- bruit)

 • Thyroid thrill

 • Ophthalmoplegia

 • Atrial fibrillation/flutter

 • Abdominal tenderness



Treatment:

 • Beta blockers

 • Thioamides (Methimazole and PTU)

 • Radioactive iodine therapy

 • Thyroidectomy



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