Hyperthyroidism: Difference between revisions
| Line 91: | Line 91: | ||
**Agitation and confusion | **Agitation and confusion | ||
==Differential Diagnosis== | ==Differential Diagnosis (Tachycardia)== | ||
*Anemia | |||
*Dehydration | |||
*[[Fever]] | |||
*Drug intoxication | |||
*Drug withdrawal | |||
*Pain | |||
*Infection | |||
*Anion gap acidosis | |||
*[[Sepsis]] | |||
*[[Hyperthyroid]] | |||
*Psych (anger, fear) | |||
*[[Arrhythmia]] | |||
*[[PE]] | |||
*[[CHF]] | |||
*[[Tamponade]] | |||
*[[Myocardial contusion]] | |||
*Cardiac valvular disease | |||
*Hyper/[[hypoglycemia]] | |||
*AMI | |||
*Toxicity | |||
**ASA | |||
**TCA | |||
**Anticholinergic | |||
**Theophylline | |||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 19:45, 18 February 2016
Background
- Hyperthyroidism: Excess circulating hormone resulting from thyroid gland hyperfunction
- Thyrotoxicosis: Excess circulating thyroid hormone originating from any cause
Causes
- Primary Hyperthyroidism
- Graves disease (toxic diffuse goiter)
- Most common cause (85% of cases)
- Associated with diffuse goiter, ophthalmopathy, local dermopathy
- Toxic multinodular goiter
- 2nd most common cause
- Toxic nodular (adenoma) goiter
- Enlarged thyroid gland w/ small nodules that overproduce thyroid hormone
- Graves disease (toxic diffuse goiter)
- Secondary Hyperthyroidism
- Thyrotropin-secreting pituitary adenoma
- Thyroiditis
- Hashimoto thyroiditis
- Initially gland is overactive (hyperthyroidism state) followed by hypothyroidism
- Subacute painful thyroiditis (de Quervain thyroiditis)
- Subacute painless thyroiditis
- Radiation thyroiditis
- Other causes
- Metastatic thyroid cancer
- Iodine-induced thyrotoxicosis
- Amiodarone (contains iodine)
- Molar pregnancy
Clinical Features
- Constitutional
- Lethargy
- Diaphoresis
- Weakness
- Fever
- Heat intolerance
- Weight loss
- Neuropsychiatric
- Emotional lability
- Fine tremor
- Anxiety
- Muscle wasting
- Confusion
- Hyperreflexia
- Coma
- Periodic paralysis
- Psychosis
- Ophthalmologic
- Diplopia
- Lid lag
- Eye irritation
- Exophthalmos
- Ophthalmoplegia
- Endocrine
- Neck fullness/tenderness (thyroid gland)
- Cardiorespiratory
- Dyspnea
- Widened pulse pressure
- Palpitations
- Systolic hypertension
- Chest pain
- Sinus tachycardia
- A-fib/flutter
- CHF
- GI
- Diarrhea
- Hyperactive bowel sounds
- Reproductive
- Oligomenorrhea
- Gynecomastia
- Telangiectasia
- Gynecologic
- Menorrhagia
- Sparse pubic hair
- Hematologic
- Anemia
- Leukocytosis
- Dermatologic
- Hair loss
- Pretibial myxedema
- Warm, moist skin
- Palmar erythema
- Onycholysis
- Apathetic hyperthyroidism (elderly patients)[1]
- Placid apaethetic facies
- Depression
- Lethargy
- Muscular weakness and wasting
- Excessive weight loss
- Cardiac dysrrhythmias
- Absent or small goiter
- Absence of ocular symptoms
- Agitation and confusion
Differential Diagnosis (Tachycardia)
- Anemia
- Dehydration
- Fever
- Drug intoxication
- Drug withdrawal
- Pain
- Infection
- Anion gap acidosis
- Sepsis
- Hyperthyroid
- Psych (anger, fear)
- Arrhythmia
- PE
- CHF
- Tamponade
- Myocardial contusion
- Cardiac valvular disease
- Hyper/hypoglycemia
- AMI
- Toxicity
- ASA
- TCA
- Anticholinergic
- Theophylline
Diagnosis
Workup
- TSH (↓)
- Free T4 (↑)
- Free T3 (↑)
Management
- If asymptomatic or mild symptoms, no treatment required in ED
- If symptomatic, consider Thyroid storm
Disposition
- If asymptomatic or no thyroid storm, discharge with outpatient follow-up.
- Admit for significant symptoms or thyroid storm.
See Also
References
- ↑ Rehman SU et al. Thyroid Disorders in Elderly Patients. South Med J. 2005;98(5):543-549.