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Thyroid Disease (Hyperthyroidism Thyrotoxicosis (DDX (Endogenous (TSH-…

- - - - Autonomous hypersecretion of T3 &T4 by functioning ademona
        *↑Elderly presenting with AF
        
        ↓TSH, ↓T3/T4
        
        B blockers for symx, Surgery, Carbimozole
    - - Iodine -Induced
        
        Drugs (amiorderone)
        Radiographic Contrast media
        
        Iodine prophylaxis Programme
      - Thryoid Storm
        
        Life threatening Acute exacerbation of all thyrotoxicosis symptoms secondary to uncontrolled hyperthyroidism
        Aet: Infection, trauma, surgery
    - - TSH- induced
      - TSH-Secreting Pituitary Adenoma
        
        Choriocarcinoma
      - Follicular Carcinoma +/_ mets
      - Papillary Carcinoma
    - - Autoimmune --> Thyroid Stimulating Immunoglobulin
        
        Most common cause of Thyrotoxicosis, peak in 30s-40s
        
        ↓TSH,↑T4, Positive TSI, RAIU- ↓Uptake, Hot nodules
        
        Aet: Postpartum, Iodine Excess, Lithium therapy Viral/bacterial infections
        *Path: T reg suppression, Glycosominaoglycan Accumulation → Proptosis & Exopthalmos
    - - Acute Inflammatory disorder with initial thryotoxic state → Hyperthyroidism → euthyroid
        
        AetPainful → viral, Painless →postpartum, autoimmune, lymphocyctic
        
        Path: Inflammatory process →release of stored thyroid hormones
        
        TX Painful: NSAIDS +
        
        TX Painless: B blockers, Iodinated Contrast Agents, short term thyroxine
- - - - Autoimmune
        
        Hashimoto's thyroditus
        
        Chronic Inflammatory destruction of thryoid tissue due TPO
        
        Female, genetics, Smoking, ↑Iodine intake
        
        ↑TSH,↓T3/T4, TPO (95% of patients,, Tg Ab
        
        Path: Defective T regs → Destruction of: thyroglobulin,TPO,TSH Rec,Na/I symporter
        
        TX: Thyroxine
      - Hypothyroid Phase of sub acute thyroiditis
      - Iatrogenic
        
        Iodine ablation
        
        Thyrodectomy
      - Drugs:
        
        Amioderone
        
        Iodine
        
        Carbimozole
        
        MMI
        
        Lithium
      - Iodine deficiency
        
        Endemic in Some Countries
        
        Cause Cretinism
      - Neoplasia
    - - Pituitary Insuffiency
    - - Hypothalamic Dusfunction
      - Peripheral tissue resistance to Thyroid Hormone
        Refetoff Syndrome