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Hyperthyroidism (Clinical presentation (Elderly (Atrial fibrillation,…
Hyperthyroidism
Clinical presentation
Hyperkinesis - muscle spasm
Warm - vasodilator peripheries
Tremor
Proximal myopathy & muscle wasting
Irritability/behavioural change
Lymphadenopathy and splenomegaly can occur
Heat intolerance i.e. sweating a lot
Anxiety
Oligomenorrhea (infrequent periods ) +/- infertility
Hands
Palmar erythema, warm moist skin and fine tremor
Weight loss & increased appetite
Elderly
Atrial fibrillation
Other tachycardias and/or heart failure
Diarrhoea
Children
Excessive height or excessive growth rate
Behavioural problem like hyperactivity
Palpitations
Diagnosis
TPO & thyroglobulin antibodies are present
Ultrasound of thyroid
Helps to differentiate Graves' from toxic adenoma
Thyroid function tests (TFTs)
Serum TSH is suppressed
Due to negative feedback produced by hyperthyroidism
T4 & T3 raised - DIAGNOSTIC
T4 is almost always raised
T3 is more sensitive
Secondary hyperthyroidism - TSH will be very elevated as problem is with pituitary
Graves' specific
TSH receptor stimulating antibodies raised - DIAGNOSTIC of GRAVES'
Mild neutropenia
Clinical
Treatment
Beta blockers
Anti-thyroid drugs
Radioactive iodine
Surgery
Epidemiology
Mainly between 20-40 years
3 diseases account for the majority of causes
Affects 2-5% of all women at some time
Aetiology
Graves' disease
Autoimmune induced excess production of thyroid hormone
Toxic Multinodular goitre
Nodules that secrete thyroid hormones
Drug induced hyperthyroidism
Usually by amiodarone, but also iodine or lithium
Differential diagnosis
Usually is clinically obvious
Differentiation of mild cases from anxiety can be difficult. Look for:
Eye signs e.g. lid lag & stare
Diffuse goitre
Proximal myopathy & wasting
Complications
Thyroid crisis or thyroid storm
Rare, life threatening condition in which there is a rapid deterioration of thyrotoxicosis (RAPID T4 INCREASE)