Hyperthyroidism
From IDWiki
Background
Etiologies
- Graves disease (autoimmune)
- Thyroiditis
- Viral (painful, subacute)
- Autoimmune
- Transient (painless)
- Post-partum thyroiditis (painless)
- Toxic nodule
- Toxic multinodular goitre
- Iatrogenic
Clinical Manifestations
Biochemical
- Laboratory dysfunction only
Subclinical
- Progresses to symptomatic hyperthyroidism in 25% by 5 years
Clinical
- History
- Heat intolerance
- Weight loss
- Anxiety
- Emotional ability
- Weakness
- Tremor
- Palpitations
- Increased perspiration
- Distractibility
- Signs & Symptoms
- Atrial fibrillation
Graves Disease
- Signs and symptoms of hyperthyroidism
- Diffuse goitre
- Proptosis, palpebral swelling
- Diffuse dermopathy
Investigations
- Labs
- TSH; if low, repeat and add free T3 and free T4
- Imaging
- Other
Management
- Depends on the underlying cause
- Methimazole
- Free T4 levels 1 to 1.5 times ULN: 5 to 10 mg once daily
- Free T4 levels >1.5 to 2 times ULN (or iodine-induced thyrotoxicosis): 10 to 20 mg once daily
- Free T4 levels >2 times ULN: 20 to 40 mg/day
- Give in 2 to 3 divided doses to minimize GI side effects
- Propylthiouracil preferred in pregnant patients
- Beta blockers
- Atenolol 25 to 50 mg p.o. daily, titrate up to get heart rate under 90 (as BP allows) to maximum of 200 mg daily in two divided doses
- Propanolol
