Thyrotoxicosis

THYROTOXICOSIS

• Thyrotoxicosis is defined as the state of thyroid hormone excess.

 ETIOLOGY-

• Primary Hyperthyroidism
• Grave’s disease
• Toxic multinodular goiter
• Toxic adenoma
• Thyroid carcinoma
• Drug iodine excess
• Thyrotoxicosis without hyperthyroidism
• Subacute thyroiditis
• Thyroid destruction
• Ingestion of excess thyroid hormone
• Secondary hyperthyroidism
• TSH secreting pituitary adenoma
• Thyroid hormone resistance syndrome
• Gestational thyrotoxicosis

CLINICAL FEATURES-

• Hyperactivity, dysphoria, systolic hypertension
• CVS- Tachycardia, midsystolic murmur, means lerman scratch (2^nd left intercoastal space), systolic ejection click.
• Palpitations and tremor
• Fatigue, weight loss, diarrhea, polyuria, glycosuria, proximal muscle weakness.
• Amenorrhea, gynecomastia
• Goiter
• Eye- Lid retraction or lag, proptosis, myxedema, unilateral exopthalmos
• Thyroid dermopathy
• Joffroy’s sign– absence of wrinkling on forehead when patient looks up.

 LAB DIAGNOSIS-

• Radionuclide scan
• Scintigraphy is a preferred test
• TRAb measurement is used to asses autoimmune activity.
• Measure TSH unbound T₄

TREATMENT-

• Antithyroid drugs- thionamides (Carbimazole for child, pregnancy), methimazole, Propylthiouracil (pregnancy- preferred)
• Thyroidectomy
• Radioiodine
• Propranolol (? blockers)used for adrenergic symptoms

 Exam Important

• Thyrotoxicosis is defined as the state of thyroid hormone excess.
• Primary Hyperthyroidism
• Grave’s disease
• Toxic multinodular goiter
• Thyrotoxicosis without hyperthyroidism
• Subacute thyroiditis
• Hyperactivity, dysphoria, systolic hypertension
• CVS- Tachycardia, midsystolic murmur, means lerman scratch (2^nd left intercoastal space), systolic ejection click.
• Fatigue, weight loss, diarrhea, polyuria, glycosuria, proximal muscle weakness.
• Eye- Lid retraction or lag, proptosis, myxedema, unilateral exopthalmos
• Thyroid dermopathy
• Joffroy’s sign- absence of wrinkling on forehead when patient looks up.
• Scintigraphy is a preferred test

TREATMENT–

• Antithyroid drugs- thionamides (Carbimazole for child, pregnancy), methimazole, Propylthiouracil (pregnancy- preferred)
• Thyroidectomy
• Radioiodine
• Propranolol (? blockers)used for adrenergic symptoms