Hyperthyroidism: Difference between revisions
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| − | == |
+ | == Background == |
| + | === Etiologies === |
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** Viral (painful, subacute) |
** Viral (painful, subacute) |
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** Autoimmune |
** Autoimmune |
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*** Transient (painless) |
*** Transient (painless) |
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| − | *** Post-partum thyroiditis (painless) |
+ | *** [[Post-partum thyroiditis]] (painless) |
* Toxic nodule |
* Toxic nodule |
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| − | * Toxic multinodular goitre |
+ | * [[Toxic multinodular goitre]] |
* Iatrogenic |
* Iatrogenic |
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| − | ** Amiodarone |
+ | ** [[Amiodarone]] |
| − | ** Lithium |
+ | ** [[Lithium]] |
== Clinical Manifestations == |
== Clinical Manifestations == |
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* Imaging |
* Imaging |
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* Other |
* Other |
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| + | |||
| + | == Management == |
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| + | |||
| + | * Depends on the underlying cause |
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| + | * [[Methimazole]] |
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| + | ** Free T4 levels 1 to 1.5 times ULN: 5 to 10 mg once daily |
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| + | ** Free T4 levels >1.5 to 2 times ULN (or iodine-induced thyrotoxicosis): 10 to 20 mg once daily |
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| + | ** Free T4 levels >2 times ULN: 20 to 40 mg/day |
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| + | ** Give in 2 to 3 divided doses to minimize GI side effects |
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| + | ** [[Propylthiouracil]] preferred in pregnant patients |
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| + | * Beta blockers |
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| + | ** [[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 |
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| + | ** [[Propanolol]] |
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[[Category:Endocrinology]] |
[[Category:Endocrinology]] |
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Latest revision as of 10:34, 28 February 2022
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
