Hyperthyroidism Clinical Hyperthyroidism Clinical ApplicationsApplications

Gail Nunlee-Bland, M.D.

Division of Endocrinology

HyperthyroidsimHyperthyroidsim

Clinical condition resulting from overactivity of the thyroid gland an an excess of circulating thyroid hormone

HyperthyroidismHyperthyroidismCausesCauses2 categoriesSustained hormone overproductionNo associated overproduction

HyperthyroidismHyperthyroidismOverproductionOverproductionGraves’ diseaseToxic multinodular goiterToxic adenomaIodine-inducedIncrease TSH secretion

HyperthyroidismHyperthyroidismNo Sustained OverproductionNo Sustained OverproductionThyrotoxicosis factitiaSubacute thyroiditischronic thyroiditis with transient

thyrotoxicosis (painless thyroiditis, silent thyroiditis, post-partum thyroiditis

Ectopic thyroidtissue (struma ovarii, functioning metastatic thyroid cancer)

Graves’DiseaseGraves’Disease

Diffuse goiterThyrotoxicosisInfiltrative orbitopathyInfiltrative dermopathy

Graves’ DiseaseGraves’ Disease

AutoimmuneAntibodies against thyroid

peroxidase, thyroglobulin and the TSH receptor

Associated with other autoimmune disorders

Graves’ DiseaseGraves’ Disease

Prevalence ~ 2.7%Incidence 1 case 1000/yrMost common cause of spontaneous

hyperthyroidism in patients younger than age 40

Organ Specific Effects of Organ Specific Effects of Graves’ DiseaseGraves’ DiseaseEyes– Infiltrative orbitopathy

Skin– Dermopathy

Clinical ManifestationsClinical ManifestationsThyrotoxicosisThyrotoxicosisSymptom %

Nervousness 99

Increased sweating 91

Heat intolerance 89

Palpitation 89

Fatigue 88

Clinical ManifestationsClinical ManifestationsThyrotoxicosisThyrotoxicosisSymptom %

Weight loss 85

Tachycardia 82

Dyspnea 75

Weakness 70

Increase appetite 65

Clinical ManifestationsClinical ManifestationsThyrotoxicosisThyrotoxicosisSign %

Tachycardia 100

Goiter 100

Skin changes 97

Tremor 97

Thyroid bruit 77

Toxic Multinodular GoiterToxic Multinodular Goiter

Generally seen in the elderly Multiple nodules are felt on exam - few of

the nodules may be hyperfunctioning on thyroid uptake scan

Signs and symptoms of hyperthyroidism are less pronounced

Less increase in thyroid hormone overproduction

Toxic AdenomaToxic Adenoma

Hyperfunctioning solitary nodule Occurs in a younger age group 30s or 40s Long-standing slowly growing lump in

neck Manifestations of hyperthyroidism - less

severe than in Graves’ disease Uptake scan may show hyperfunctioning

nodule

Transient HyperthyroidismTransient Hyperthyroidism

Subacute thyroiditis– thyroid pain– Elevated sedimentation rate

Silent thyroiditis– no thyroid pain

Postpartum thyroiditis Factitious hyperthyroidism– ingestion of thyroid hormone

Decreased iodide uptake on thyroid scan

Laboratory InvestigationsLaboratory Investigations

TSHFree T4T3RIAThyroid antibodies– Thyroid stimulating immunoglobulins

Thyroid uptake scan

TBGResin

T4

Euthyroid

TBGResin

Hyperthyroid

T4 T3RU TSH

Increase Uptake ScanIncrease Uptake Scan

HyperthyroidismIodine deficiency

Decrease Uptake ScanDecrease Uptake Scan

Subacute thyroiditisFactitious thyroiditisAntithyroid agents

TreatmentTreatment

Antithyroid drugs– Propylthiouracil–Methimazole

Beta blockersSurgeryRadioactive iodine

Thank YouThank You