Hyperthyroidism
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Hyperthyroidism is caused by Graves' disease, toxic multinodular goiter, or a toxic nodule. It increases the metabolic rate and causes symptoms like palpitations, weight loss, nervousness, and eye changes. Graves' disease is an autoimmune disorder where TSHR antibodies stimulate the thyroid. Treatment options include antithyroid medications, radioactive iodine therapy, or thyroidectomy. Subclinical hypothyroidism is when TSH is elevated but T3 and T4 are normal, while subclinical hyperthyroidism is when TSH is suppressed but T3 and T4 are normal.
Hyperthyroidism
- 1. HYPERTHYROIDISM Dr Sravan Kumar G M.D.Medicine (PGIMER) Assistant Professor MRIMS
- 2. etiology Graves disease Toxic Multinodular goitre Toxic nodule
- 3. Cardiovascular System hypermetabolism and the need to dissipate the excess heat produced peripheral vascular resistance is decreased, and cardiac output is increased first increase in heart rate and with more severe disease, in stroke volume. increased sympathetic and decreased vagal tone Palpitations Cardiac arrhythmias Atrial fibrillation
- 4. Protein, Carbohydrate, and Lipid Metabolism degradation rates of proteins are increased, decrease in tissue protein, loss of weight, muscle wasting, proximal muscle weakness, mild hypoalbuminemia Preexisting diabetes mellitus – aggravated - accelerated turnover of insulin lipolysis - increase in the plasma concentration of free fatty acids and glycerol and a decrease in serum cholesterol level & triglyceride levels
- 5. Sympathetic Nervous System and Catecholamines thyroid hormones increase sensitivity to catecholamines in both cardiomyocytes and adipocytes by a variety of mechanisms.
- 6. Nervous System Fatigue Nervousness emotional lability Hyperkinesia fine tremor of the hands, tongue, or lightly closed eyelids
- 7. Muscle Proximal muscle weakness - diffculty in climbing stairs or fatigue from minimal exertion such as using a blow dryer or lifting an infant
- 8. Eyes retraction of the upper or lower eyelids, or both - presence of a rim of sclera between either lid and the limbus – typical stare lid lag, a phenomenon in which the upper lid lags behind the globe when the patient is asked to shift the gaze slowly downward globe lag, which becomes evident when the eye lags behind the upper lid when the patient looks up increased adrenergic tone
- 9. Skin and Hair warm, moist feel of the skin - cutaneous vasodilation and excessive sweating Palmar erythema hair is fine and friable, and hair loss may increase
- 11. Alimentary System Increased apetite & weight loss
- 12. Skeletal System: Calcium and Phosphorus Metabolism increased excretion of calcium and phosphorus in urine and stool-increase in bone turnover and a net demineralization of bone
- 13. Reproductive system Amenorrhea, infertility Gynecomastia - androstenedione to testosterone, estrone, and estradiol increased rate of conversion of androgens to estrogenic byproducts - gynecomastia - erectile dysfunction
- 14. Graves disease
- 15. autoimmune disorder TSHR antibodies (TRAb) 80% of all cases of thyrotoxicosis Natural History and Course of Graves Disease - unpredictable
- 16. Graves Orbitopathy 1)extraocular muscle and adipose tissue are swollen-accumulation in the extracellular matrix of glycosaminoglycans (GAGs) and new fat cell development (adipogenesis) within the orbit. 2)GAGs are secreted by fibroblasts under the influence of TRAbs, level of TRAbs often correlates with the severity of the eye disease 3)risk factors - Smoking & Radioiodine
- 17. Graves dermopathy compression of the dermal lymphatics and nonpitting edema
- 18. Investigations TSH (<0.1 mIU/mL) , T3, T4 – high TRAbs Anti TPO Ab
- 19. Treatment Choose between 1) Anti thyroid drugs (Contraindication: previous known adverse effects to antithyroid drugs) 2) RAI therapy (Contraindication: pregnancy, lactation, coexisting thyroid cancer) 3) Thyroidectomy Antithyroid Agents 10 mg of carbimazole = 6 mg of methimazole T Carbimazole 10 mg BD/ T Methimazole 10 mg BD Maintanence dose – 5 to 10 mg/day Propronolol (T INDEROL 10 mg BD)
- 20. Hyperthyroidism in pregnancy Potency methimazole to PTU is around 20:1 1 st trimester – PTU 2 nd trimester – Methimazole/ carbimazole
- 21. Multinodular goitre Solitary nodule
- 22. Subclinical hypothyroidism TSH – 4 to 10 mIU/mL Treat if 1) Symptoms of Hypothyroid 2) Goitre 3) High Antibody titre of Anti TPO Ab 4) has Cardiovascular disease 5) Pregnancy Treatment doses half of hypothyroidism TSH – 0.1 to 0.4 Postmenopausal osteoporosis Rheumatic valvular disease with left atrial enlargement or atrial fbrillation Congestive heart failure Angina pectoris Infertility or menstrual disorders Nonspecifc symptoms such as fatigue, nervousness, depression, or gastrointestinal disorders, especially in patients older than 60 years of age (consider therapeutic trial) Subclinical hyperthyroidism