Hyperthyroidism Assessment And Cause

Hyperthyroidism Assesment And Cause

Hyperthyroidism Presentation:

The patient has tremor of outstretched hands

Palm of the hands are warm and sweaty

Pulse – 120/min (Tachycardia. Pulse may be normal, if the patient is on B-blocker)

If you suspect a patient is suffering from hyperthyroidism, what else do you want to examine?

Answer: I want to examine the Thyroid Gland, Eye, CVS, and Jerks

If you think the patient is suffering from hyperthyroidism what question will you ask him?

Answer: I should ask the patient

1)      Do you prefer hot or cold? (Heat intolerance)

2)      Are you losing weight? (Weight loss common)

3)      How is your appetite? (Increased Appetite)

4)      How is your Bowel habit (Diarrhea may occur)

5)      In Female, Ask about menstruation, (Usually amenorrhea in thyrotoxicosis)

6)      Others – Excessive seating, Palpitation, Tremor, Irritability, Insomnia, Nervousness

Fig: hypo vs hyperthyroidism

Causes Of  Thyrotoxicosis:

1)      Grave’s Disease – commonest Cause (76%)

Fig: Grave’s Disease

2)      Toxic Multinodular Goitre – (14%)

3)      Toxic Nodular Goitre

4)      Thyroiditis (Subacute Thyroiditis – De Quervain’s Thyroiditis)

De Quervain’s thyroiditis

This is transient hyperthyroidism from an acute inflammatory process, probably viral in origin.  Apart  from  the  toxicosis, there  is  usually  fever,  malaise  and  pain  in  the  neck  with tachycardia  and  local  thyroid  tenderness.  Thyroid function tests show initial hyperthyroidism, the erythrocyte sedimentation rate (ESR) and plasma viscosity are raised, and thyroid uptake scans  show  suppression  of  uptake  in  the  acute phase. Hypothyroidism, usually transient, may then follow after a few weeks. Treatment of the acute phase is with aspirin, using short-term prednisolone in severely symptomatic cases.

5)      Hashimoto’s thyroiditis

Who is Hashimoto?

Fig: Hakaru Hashimoto

Hakaru Hashimoto was a Japanese medical scientist. He was born on May 5, 1881 and fell ill with typhoid fever and died at home on January 9, 1934.

6)      Factitious thyrotoxicosis

7)      Iodine Induced (Jod Basedow’s Phenomenon) Or Drug Induced (Amiodarone)

8)       Others –rare

1. Follicular carcinoma of thyroid
2. Struma-ovarii
3. Hydatidiform mole and choriocarcinoma

What is Factitious thyrotoxicosis?

Deliberate intake of thyroxine to reduce weight, usually in emotionally disturbed person. Clue for diagnosis are – high thyroid hormones, low radio iodine uptake. Thyroglobulin level is zero or low. High ratio of T4:T3 = 70:1 (Conventional thyrotoxicosis, ratio 30:1) combination of negligible radioiodine uptake, high T4:T3 ratio and low thyroglobulin level is diagnostic.

Fig: Thyrotoxicosis