Hyperthyroidism overt and mild
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Hyperthyroidism (overt and mild). Manifestations and diagnosis. Graves ophthalmopathy. Graves ophthalmopathy. Graves disease. Localized myxedema of the toe. Thyrotoxic periodic paralysis. Figure 3 Thyrotoxic periodic paralysis pathophysiology hypothesis.

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Hyperthyroidism (overt and mild)

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Hyperthyroidism(overt and mild)

Manifestations and diagnosis


Graves ophthalmopathy


Graves ophthalmopathy


Graves disease


Localized myxedema of the toe


Thyrotoxic periodic paralysis


Figure 3Thyrotoxic periodic paralysis pathophysiology hypothesis

Maciel, R. M. B. et al. (2011) Novel etiopathophysiological aspects of thyrotoxic periodic paralysis

Nat. Rev. Endocrinol. doi:10.1038/nrendo.2011.58


Toxic MNG


Toxic adenoma


Subacutethyroiditis


Symptoms of overt hyperthyroidism

  • Anxiety

  • Emotional lability

  • Weakness

  • Tremor

  • Palpitations

  • Heat intolerance

  • Increased perspiration

  • Weight loss despite a normal or increased appetite, gain weight

  • Hyperdefecation (not diarrhea)

  • Urinary frequency

  • Oligomenorrhea or amenorrhea

  • Gynecomastia

  • Erectile dysfunction

Isolated symptoms and signs:

  • Unexplained weight loss

  • New onset atrial fibrillation Myopathy

  • Menstrual disorders

  • gynecomastia.

  • Osteoporosis

  • Hypercalcemia

  • Heart failure

  • Premature atrial contractions

  • shortness of breath

  • Deterioration in glycemic control in patients with previously diagnosed diabetes.


Signs of overt hyperthyroidism

  • Hyperactivity and rapid speech.

  • Lid retraction and lid lag

  • warm and moist skin

  • Thin and fine hair

  • Tachycardia

  • Atrial fibrillation

  • Systolic hypertension may be present

  • Hyperdynamicprecordium

  • Tremor

  • Proximal muscle weakness

  • Hyperreflexia

Only in patients with Graves' disease:

1) Graves ophthalmopathy

  • Exophthalmos

  • Periorbital and conjunctival edema

  • Limitation of eye movement

    2) pretibialmyxedema

  • Infiltrative dermopathy


Diagnosis

Low serum TSH

High serum T4 and or high serum T3


Mild (subclinical) hyperthyroidism

Normal T4 and T3

Suppressed TSH


Subclinical hyperthyroidism

  • Mild to moderate iodine deficiency

  • Females

  • Smokers

  • Elderly

Prevalence in the community in older than 55 yrears: 0.7%-12.4%


Differential diagnosis of subclinical hyperthyroidism

  • Central hypothyroidism

  • Nonthyroidal illness

  • Recovery from hyperthyroidism, including thyroiditis


Subclinical hyperthyroidism

Increased risk of mortality :

Small

Increases with

  • Age

  • degree of TSH suppression


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