HYPERTHYROIDISM

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Thyrotoxicosis is the clinical syndrome that results when tissues are exposed to high levels of circulating thyroid hormones. It results in a generalized acceleration of metabolic processes. - Hyperthyroidism: hyperactivity of the thyroid gland. Table 1. Conditions Associated with Thyrotoxicosis. 1. Diffuse toxic goiter (Graves' disease) 2. Toxic adenoma (Plummer's disease)

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HYPERTHYROIDISM - Thyrotoxicosis is the clinical syndrome that results when tissues are exposed to high levels of circulating thyroid hormones. It results in a generalized acceleration of metabolic processes. - Hyperthyroidism: hyperactivity of the thyroid gland. Table 1. Conditions Associated with Thyrotoxicosis. 1. Diffuse toxic goiter (Graves' disease) 2. Toxic adenoma (Plummer's disease) 3. Toxic multinodular goiter 4. Subacute thyroiditis 5. "Silent" thyroiditis 6. Thyrotoxicosis factitia
7. Rare forms of thyrotoxicosis: ovarian struma, metastatic thyroid carcinoma (follicular), hydatidiform mole, "hamburger thyrotoxicosis," TSH -secreting pituitary tumor, pituitary resistance to T3 and T4. Clinical Findings: • Symptoms include heat intolerance, weight loss, weakness, palpitations, oligomenorrhea, and anxiety. • Signs include brisk tendon reflexes, fine tremor, proximal weakness, stare, and eyelid lag. Cardiac abnormalities may be prominent, including sinus tachycardia, atrial fibrillation, and exacerbation of coronary artery disease or heart failure. • In the elderly, hyperthyroidism may present with only atrial fibrillation, heart failure, weakness, or weight loss, and a high index of suspicion is needed to make the diagnosis. Diagnosis • Hyperthyroidism should be suspected in any patient with compatible symptoms, as it is a readily treatable disorder that may become very debilitating. • Plasma TSH is the best initial diagnostic test, as a TSH level >0.1 microunits/mL excludes clinical hyperthyroidism. If plasma TSH is
- If plasma TSH is < 0.1 microunits/mL but free T4 is normal, the patient may have clinical hyperthyroidism due to elevation of plasma T3 alone; therefore, plasma T3 should be measured in this case. -Very mild (or subclinical) hyperthyroidism may suppress TSH to