Hyperthyroidism Assesment And Cause
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
- Follicular carcinoma of thyroid
- 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.