Hyperthyroidism: Difference between revisions
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==Clinical Features==
==Clinical Features==
*Constitutional
'''Constitutional signs:''
**Lethargy
*Lethargy
**Diaphoresis
*Diaphoresis
**Weakness
*Weakness
**Fever
*Fever
**Heat intolerance
*Heat intolerance
**Weight loss
*Weight loss
*Neuropsychiatric
'''Neuropsychiatric:''
**Emotional lability
*Emotional lability
**Fine tremor
*Fine tremor
**Anxiety
*Anxiety
**Muscle wasting
*Muscle wasting
**Confusion
*Confusion
**Hyperreflexia
*Hyperreflexia
**Coma
*Coma
**Periodic paralysis
*Periodic paralysis
**Psychosis  
*Psychosis  
*Ophthalmologic
'''Ophthalmologic:'''
**[[Diplopia]]
*[[Diplopia]]
**Lid lag
*Lid lag
**Eye irritation
*Eye irritation
**Exophthalmos
*Exophthalmos
**Ophthalmoplegia
*Ophthalmoplegia
*Endocrine
'''Endocrine:'''
**Neck fullness/tenderness (thyroid gland)
**Neck fullness/tenderness (thyroid gland)
*Cardiorespiratory
'''Cardiorespiratory:'''
**Dyspnea
*Dyspnea
**Widened pulse pressure
*Widened pulse pressure
**Palpitations
*Palpitations
**Systolic hypertension
*Systolic hypertension
**Chest pain
*Chest pain
**Sinus tachycardia
*Sinus tachycardia
**A-fib/flutter
*A-fib/flutter
**CHF
*CHF
*GI
'''GI:'''
**Diarrhea
*Diarrhea
**Hyperactive bowel sounds
*Hyperactive bowel sounds
*Reproductive
'''Reproductive:'''
**Oligomenorrhea
*Oligomenorrhea
**Gynecomastia
*Gynecomastia
**Telangiectasia
*Telangiectasia
*Gynecologic
'''Gynecologic:'''
**Menorrhagia
*Menorrhagia
**Sparse pubic hair
*Sparse pubic hair
*Hematologic
'''Hematologic:'''
**Anemia
*Anemia
**Leukocytosis
*Leukocytosis
*Dermatologic
'''Dermatologic:'''
**Hair loss
*Hair loss
**Pretibial myxedema
*Pretibial myxedema
**Warm, moist skin
*Warm, moist skin
**Palmar erythema
*Palmar erythema
**Onycholysis
*Onycholysis
*Apathetic hyperthyroidism (elderly patients)<ref>Rehman SU et al. Thyroid Disorders in Elderly Patients. South Med J. 2005;98(5):543-549.</ref>
'''Apathetic hyperthyroidism:''' (elderly patients)<ref>Rehman SU et al. Thyroid Disorders in Elderly Patients. South Med J. 2005;98(5):543-549.</ref>
**Placid apaethetic facies
*Placid apaethetic facies
**Depression
*Depression
**Lethargy
*Lethargy
**Muscular weakness and wasting
*Muscular weakness and wasting
**Excessive weight loss
*Excessive weight loss
**Cardiac dysrrhythmias
*Cardiac dysrrhythmias
**Absent or small goiter
*Absent or small goiter
**Absence of ocular symptoms
*Absence of ocular symptoms
**Agitation and confusion
*Agitation and confusion


==Differential Diagnosis (Tachycardia)==
==Differential Diagnosis (Tachycardia)==

Revision as of 00:49, 22 May 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

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:

Clinical Features

'Constitutional signs:

  • 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)

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

  1. ↑ Rehman SU et al. Thyroid Disorders in Elderly Patients. South Med J. 2005;98(5):543-549.
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