HYPERTHYROIDISM . (thyroid over activity, thyrotoxicosis). It is common, affecting perhaps 2-5% of all females at some time and with a sex ratio of 5 : 1. Most often between ages 20 and 40 years.
(thyroid over activity, thyrotoxicosis)
Proptosis and lid lag.
Waxy infiltrative plaques and edema,consistent
with infiltrative dermopathy of Grave’s disease.
Toxic solitary adenoma/nodule (Plummer's disease):
N.B. Apathetic thyrotoxicosis
It occures in some elderly patients ,the clinical presentation is more like hypothyroidism, with very few signs and so, high degree of clinical suspicion is essential.
Differential diagnosis :
There are many variations of antithyroid drug regimens:
Gradual dose titration
1. Review after 4-6 weeks and reduce dose of carbimazole depending on clinical state and T4/T3 levels. TSH levels may remain suppressed for several months and are unhelpful at this stage.
2. When clinically and biochemically euthyroid, stop beta-blockers.
3. Review after 2-3 months and, if controlled, reduce carbimazole.
4. Gradually reduce dose to 5 mg daily over 6-24 months if hyperthyroidism remains controlled.
5. When the patient is euthyroid on 5 mg daily carbimazole, discontinue.
About 50% of patients will relapse after a course of carbimazole or propylthiouracil, mostly within the following 2 years but occasionally much later.
Indications for either surgery or radioiodine are:
Thyroid crisis or 'thyroid storm'