Hyperthyroidism Clinical Applications Gail Nunlee-Bland, M.D. Division of Endocrinology.
Transcript of Hyperthyroidism Clinical Applications Gail Nunlee-Bland, M.D. Division of Endocrinology.
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Hyperthyroidism Clinical Hyperthyroidism Clinical ApplicationsApplications
Gail Nunlee-Bland, M.D.
Division of Endocrinology
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HyperthyroidsimHyperthyroidsim
Clinical condition resulting from overactivity of the thyroid gland an an excess of circulating thyroid hormone
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HyperthyroidismHyperthyroidismCausesCauses2 categoriesSustained hormone overproductionNo associated overproduction
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HyperthyroidismHyperthyroidismOverproductionOverproductionGraves’ diseaseToxic multinodular goiterToxic adenomaIodine-inducedIncrease TSH secretion
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HyperthyroidismHyperthyroidismNo Sustained OverproductionNo Sustained OverproductionThyrotoxicosis factitiaSubacute thyroiditischronic thyroiditis with transient
thyrotoxicosis (painless thyroiditis, silent thyroiditis, post-partum thyroiditis
Ectopic thyroidtissue (struma ovarii, functioning metastatic thyroid cancer)
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Graves’DiseaseGraves’Disease
Diffuse goiterThyrotoxicosisInfiltrative orbitopathyInfiltrative dermopathy
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Graves’ DiseaseGraves’ Disease
AutoimmuneAntibodies against thyroid
peroxidase, thyroglobulin and the TSH receptor
Associated with other autoimmune disorders
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Graves’ DiseaseGraves’ Disease
Prevalence ~ 2.7%Incidence 1 case 1000/yrMost common cause of spontaneous
hyperthyroidism in patients younger than age 40
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Organ Specific Effects of Organ Specific Effects of Graves’ DiseaseGraves’ DiseaseEyes– Infiltrative orbitopathy
Skin– Dermopathy
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Clinical ManifestationsClinical ManifestationsThyrotoxicosisThyrotoxicosisSymptom %
Nervousness 99
Increased sweating 91
Heat intolerance 89
Palpitation 89
Fatigue 88
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Clinical ManifestationsClinical ManifestationsThyrotoxicosisThyrotoxicosisSymptom %
Weight loss 85
Tachycardia 82
Dyspnea 75
Weakness 70
Increase appetite 65
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Clinical ManifestationsClinical ManifestationsThyrotoxicosisThyrotoxicosisSign %
Tachycardia 100
Goiter 100
Skin changes 97
Tremor 97
Thyroid bruit 77
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Toxic Multinodular GoiterToxic Multinodular Goiter
Generally seen in the elderly Multiple nodules are felt on exam - few of
the nodules may be hyperfunctioning on thyroid uptake scan
Signs and symptoms of hyperthyroidism are less pronounced
Less increase in thyroid hormone overproduction
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Toxic AdenomaToxic Adenoma
Hyperfunctioning solitary nodule Occurs in a younger age group 30s or 40s Long-standing slowly growing lump in
neck Manifestations of hyperthyroidism - less
severe than in Graves’ disease Uptake scan may show hyperfunctioning
nodule
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Transient HyperthyroidismTransient Hyperthyroidism
Subacute thyroiditis– thyroid pain– Elevated sedimentation rate
Silent thyroiditis– no thyroid pain
Postpartum thyroiditis Factitious hyperthyroidism– ingestion of thyroid hormone
Decreased iodide uptake on thyroid scan
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Laboratory InvestigationsLaboratory Investigations
TSHFree T4T3RIAThyroid antibodies– Thyroid stimulating immunoglobulins
Thyroid uptake scan
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TBGResin
T4
Euthyroid
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TBGResin
Hyperthyroid
T4 T3RU TSH
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Increase Uptake ScanIncrease Uptake Scan
HyperthyroidismIodine deficiency
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Decrease Uptake ScanDecrease Uptake Scan
Subacute thyroiditisFactitious thyroiditisAntithyroid agents
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TreatmentTreatment
Antithyroid drugs– Propylthiouracil–Methimazole
Beta blockersSurgeryRadioactive iodine
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Thank YouThank You