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Hyperthyroid Disorders (thyrotoxicosis) - Coggle Diagram
Hyperthyroid Disorders (thyrotoxicosis)
classification
• Toxic diffuse goiter (Graves disease): Most common hyperthyroid disorder, autoimmune disorder with thyroid-stimulating antibodies directed at thyrotropin receptors
• Pituitary adenomas: Excessive TSH secretion that does not respond to normal T3 negative feedback
• Toxic adenoma: Nodule in thyroid, autonomous of pituitary and TSH
• Toxic multinodular goiter (Plummer disease): Autonomous follicles causing excessive thyroid hormone secretion
• Painful subacute thyroiditis: Self-limiting inflammation caused by viral invasion
• Drug induced (e.g. excessive thyroid hormone or amiodarone therapy)
o Hepatotoxicity risk (boxed warning for PTU)
Consider baseline liver function tests
Routine evaluation of liver function while receiving antithyroid agents has not been shown to prevent severe hepatotoxicity
o Rash
o Arthralgia, lupus-like symptoms
o Fever
o Agranulocytosis early in therapy (usually within 3 months)
Guidelines recommend a baseline complete blood cell count
No routine monitoring recommended
Can repeat if patient becomes febrile or develops pharyngitis
o Acute pancreatitis with methimazole
Parentssss
Adverse effects
2.1. Hepatotoxicity risk (boxed warning for PTU)
2.1.1. Consider baseline liver function tests
2.1.2. Routine evaluation of liver function while receiving antithyroid agents has not been shown to prevent severe hepatotoxicity
2.2. Rash
2.3. Arthralgia, lupus-like symptoms
2.4. Fever
2.5. Agranulocytosis early in therapy (usually within 3 months)
2.5.1. Guidelines recommend a baseline complete blood cell count
2.5.2. No routine monitoring recommended
2.5.3. Can repeat if patient becomes febrile or develops pharyngitis
2.6. Acute pancreatitis with methimazole
Efficacy
3.1. Slow onset in reducing symptoms (weeks)
3.2. Maximal effect may take 4–6 months
3.3. Neither drug appears superior to the other in efficacy
3.4. On a milligram-to-milligram basis, methimazole is 10-fold more potent than propylthiouracil
3.5. Remission rates low: 20%–30%
3.6. Remission defined as normal TSH and T4 for 1 year after discontinuing antithyroid therapy