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Thyrotoxicosis (hyperthyroid)

Terms in this set (18)

Is most hyperthyroid congenital or acquired? hypo?
hyper - mostly acquired
hypo - mostly congenital
What are the relative levels of T3/T4 and TSH in the following conditions:
Hyperthyroidism (Primary)
Subclinical Hyperthyroidism
Hyperthyroidism (Secondary)
Hyperthyroidism (Primary):
FT4 high FT3 high TSH low

Subclinical Hyperthyroidism:
FT4 nl FT3 nl TSH low

Hyperthyroidism (Secondary):
FT4 high FT3 high TSH high
* What are common causes of Thyrotoxicosis?
Hyperthyroid:
Graves' Disease
Toxic Multinodular Goiter
Solitary Toxic Nodule
Iodine Excess (Jod-Basedow)
Struma Ovarii
Functional Thyroid Cancer Metastases

Non-hyperthyroid Thyrotoxicosis:
Subacute Thyroiditis (Painful)
Silent and post-partumThyroiditis
Inflammatory processes
Medications, eg, amiodarone
Radiation
Exogenous hormone ingestion
** What are the Abs in Graves disease?
TRAb (Thyroid-receptor antibodies) that bind to the TSH-Receptor --> ACTIVATING
* There are many sx of hyperthyroidism, what are the main ones:
recall: thyroid = metabolism, so everything is revved up:

Hyperactivity, Irritability, Dysphoria, Insomnia
*Heat Intolerance, Sweating
Palpitations
Fatigue, Weakness
Weight Loss, Hyperphagia, Frequent bowel movements
Oligo- or amenorrhea
Tremor, Insomnia
* What are two common symptoms of Graves? (beyond the common hyperthyroid sx)
Dermopathy: myxedema
Orbitopathy:
What sx are common to both hyper and hypothyroid?
fatigue, hair loss, amenorrhea, infertility
* What is a thyrotoxic thyroid feel like? what is normal radioiodine uptake?
Firm, diffuse enlargement 2-3x nl size
nl is under 30% uptake
* Why does thyrotoxicosis cause "stare" in graves orbitopathy?
Any Thyrotoxicosis increases sympathetic activity --> lid retraction
* What are the signs of Graves Orbitopathy?
Symptoms may occur without signs; grittiness, dryness, tearing
Scleral Injection / Chemosis
Periorbital Edema
Impaired ocular movement
Proptosis (Exophthalmos): Measure with exophthalmomete
Corneal exposure/damage
Optic nerve damage, blindness
What is the second most common cause of hyperthyroidism?
TOXIC MULTINODULAR GOITER: Autonomously functioning tissue, more commonly in elderly, may be precipitated by an iodine load (Jod-Basedow Syndrome)
What is a common cause for a solitary toxic nodule? "hot"
somatic, activating mutations of the TSH-receptor
What other hormone can bind TSH-receptors, inducing thyrotoxicosis?
hCG (need a lot)
* How do symptoms of thyrotoxicosis differ in elderly pts? why is this important?
More common: apathy, lethargy, weight loss, depression, altered mentation
Less common: hyperphagia, sweating, warm skin, palpable goiter, tremor

Often misdiagnosed as depression, dementia, cancer
* What is the medical tx for hyperthyroid conditions?
Thionamides (Methimazole (MMI))
In what cases would I-131 be used as therapy?
kill a toxic nodule or thyroid cancer (beta-emission)
*What are other non-thionamide medications for hyperthyroidism?
Beta blockers - Used for symptom relief and/or heart rate control (no direct effect on thyroid gland)

Iodine (counterintuitive) - Acutely reduces release of stored T4 and T3 -- decreases iodine uptake AND synthesis of T4, T3 (Wolff-Chaikoff Effect)
Is there a common medical treatment for sub-acute thyrotoxicosis?
No real drugs: Primarily supportive therapy (beta blockers, NSAIDS)
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