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Hyperthyroidism - Coggle Diagram
Hyperthyroidism
Complications
Increased risk of A. Fib
Embolic stroke
Heart Failure
Femur fracture
Infertility
Anxiety/irritability
Thyroid storm
Pretibial myxedema
Respiratory distress
Physical Assessment
Neuro/Psych
ROS:
Nervousness, irritable, trouble sleeping, mood changes
Physical Exam:
Fine tremor, hyperreflexia, restlessness
Cardiovascular
ROS:
Palpitations, racing heart, leg swelling
Physical Exam:
Tachycardia, irregular rhythm, widen pulse pressure, LE edema
Respiratory
ROS:
Shortness of breath with activity
Physical Exam:
Increased respiratory rate, dyspnea on exertion
Integumentary
ROS:
Increased heat intolerance, sweating more than usual
Physical Exam:
Warm skin, diaphoretic, smooth skin, pretibial myxedema
GI & Metabolic
ROS:
Weight changes, appetite change, changes in bowel consistency or increased bowel frequency
Physical Exam:
Weight loss, hyperactive bowel sounds
Musculoskeletal
ROS:
Weakness, tiring easily, episodes of sudden weakness
Physical Exam:
Proximal muscle weakness, difficulty rising from seated position
HEENT
ROS:
Vision changes, double vision, gritty or irritated eyes, light sensitivity
Physical Exam:
Lid lag, lid retraction/stare, exophthalmos, EOM limits
Neck & Endocrine
Physical Exam:
Diffuse goiter vs Nodules on palpation, thyroid bruit
ROS:
Neck swelling, trouble swallowing
Reproductive
ROS:
Decreased menstrual flow or irregular periods, impaired fertility, decreased libido, erectile dysfunction
Physical Exam: gynecomastia in males
Epidemiology
Prevalence
Overall prevalence in females is 1-3%
1.2% of US population
Incidence
20–50 cases per 100,000 people per year,
Risk factors
Female sex (8:1)
White race
Too much or too little iodine intake
Age between 20-40 yo
Certain medications
Tobacco use
Family history of Grave's disease
Screening
USPTF: Routine screening of asymptomatic adults for thyroid dysfunction is not universally recommended
Prevention
Smoking cessation
Avoiding excessive iodine and iodine-containing drugs
Morbidity/mortality
3x more risk of A.Fib.
Heart Failure
Increased risk of all-cause mortality
Toxic periodic paralysis
Osteoporosis
Infertility in women
Causes
Pathophysiology
Hypothalamus
TRH
Anterior pituitary
TSH
TSH receptor (T4 > T3)
Thyroid follicole
Trap Iodine (NIS)
Abnormal stimulator of TSH receptor
High uptake
Organify, couple (TPO)
Autonomous tissue that ignores TSH
Store in colloid
Follicle destruction
Low Uptake
Proteolysis, release
Circulation (T4 --> T3 by 5'-deiodinase
Hormone from outside the thyroid
Target tissues
Diagnosis
Diagnostic Testing
Screening:
TSH
Confirmation:
Free T4, Free T3
Determine Cause:
TRAb/TSI, RAIU, and thyroid scan
Supporting Tests:
ECG, thyroglobulin, potassium, hCG, baseline CBC and Liver function tests
Differential Diagnosis
Low Uptake:
Subacute thyroiditis, silent thyroiditis, iodine-induced, factitious
Non-thyroid Mimics:
Anxiety/panic, mania, stimulants, medications, withdrawal, arrhythmias, anemia, infection, malignancy, malabsorption, essential tremor, myasthenia gravis, perimenopause, pheochromocytoma
High/Normal Uptake:
Graves, toxic adenoma, toxic multinodular goiter
Lab Mimics:
Estrogen/pregnancy, thyroid hormone resistance, suppressed TSH from steroids, illness, or pituitary dysfunction
Treatment
Patient Centered Care
Medical History