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Learn about hyperthyroidism, its symptoms, causes, diagnosis, and treatment options such as antithyroid drugs, radioactive iodine, and thyroid surgery. Discover the differentiation from other conditions, like anxiety neurosis, and complications like hypothyroidism post-radioiodine treatment.
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Introduction • Definition：Function of thyroidism metabolism many systems excitability • Most common is diffuse toxic goiter (Graves disease, GD) , 85%
Various causes • Graves disease: 85% • Autonomous toxic adenomas of the thyroid: Plummer's disease or toxic multinodular goiter • Jodbasedow disease(Iodine-induced HT) • Functioning thyroid carcinoma • TSH hypersecretion by the pituitary • Struma ovarii • Subacute thyroiditis • Hashimoto's thyroiditis • Thyrotoxicosis factitia • Carcinoma accompanying thyrotoxicosis
Graves disease 85% Male to female 1:4-6 Chief clinical findings • Symptoms due to Hypermetabolism • goitor • Ophthalmopathy
Etiology and Pathophysiology • Abnormal immune: TRAb • Heredity • Infection: Molecular mimicry Cytokine Superantigen • Spiritirritation
Clinical manifestation Common • Symptoms due to Hyper metabolism: Heat intolerance, excessive perspiration, warm moist smooth skin, fatigue, weight loss. • Goitor: Enlargement or nodules • Ophthalmopathy: A sense of irritation in eyes, excessive tearing, exophthalmos, blurred vision, easy tiring of the eyes, double vision.
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Clinical manifestation Common • Nervous system: Nervousness, emotional lability, irritability, fine tremor of hands. • Cardiovascular: Palpitation, tachycardia, atrial fibrillation, widened pulse pressure. • Gastrointestinal: Increased appetite, Hyperdefecation, diarrhea • Hematologic system: Moderate neutropenia, mild anemia. • Others: Muscle atrophy, oligomenorrhear.
Clinical manifestation Exceptive • T3 Toxicosis: initial phases or a relapse of GD • T4 Toxicosis • Apathetic hyperthyroidism • Thyrotoxic crisis • Thyrotoxic myopathy: Hypokalemic periodic paralysis etc. • Hyperthyroidism in pregnancy • Cardiac complications: atrial fibrillation
Laboratory Diagnosis • Serum T3, T4, FT3, FT4 • Sensitive TSH assay • Serum TRAb • Test of TRH irritation • Radioactive iodine uotake: Normal: 3h 5-25%, 24h 20-45%, peak at 24h • Thyroid scan: 131I, 99mTc
Diagnosis • Symptoms • Signs • Laboratory examination
Differential diagnosis • Other causes of thyrotoxicosis • Anxiety neurosis or mania • Some states of hypermetabolism without thyrotoxicosis: severe anemia, leukemia, etc. • Cardiac disease: atrial fibrillation, angina • Pheochromocytoma • Other causes of ophthalmoplegia (myasthenia gravis) and exophthalmos (orbital tumor) • Others: COPD, DM, cirrhosis of the liver.
Treatment • Antithyroid drugs: Thionamides • Radioactive iodine(131I) • Thyroid surgery
Thionamides : Treatment • Common use: a. Methimazole b. Propylthiouracil • Dosage and duration of thionamides • Adverse action: agranulocytosis, rash( including hives), Hepatitis(with PTU), Arthralgia, myalgia, neuritis, cholestasis(with MMI) • Relapse
Treatment • Other medicine • Iodinating agents • Beta-blocking agents: Propranolol • Thyroid hormone
Treatment • Radioactive iodine(131I) • Indication: • Contraindication: female in pregnancy or the person less than 25y, etc. • Complication: Hypothyroidism, the incidence is significant during the first year or two after treatment and continues to increase at a rate of 5%y thereafter. The incidence of postradioiodine hypothyroidism at 5 y is 30% and at 10 y is 40%.
Treatment • Thyroid surgery • Indication: • Contraindication:
Treatment • Thyrotoxic crisis • Infiltrating exophthalmos Somastatin • Hyperthyroidism in pregnancy
