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.
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
(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'