Hyperthyroidism: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
===Workup=== | ===Workup=== | ||
* | *TSH (↓) | ||
* | *Free T4 (↑) | ||
* | *Free T3 (↑) | ||
==Management== | ==Management== | ||
* | *If asymptomatic or mild symptoms, no treatment required in ED | ||
* | *If symptomatic, consider [[Thyroid storm]] | ||
==Disposition== | ==Disposition== | ||
*If asymptomatic or no thyroid storm, discharge with outpatient follow-up. | |||
*Admit for significant symptoms or thyroid storm. | |||
==See Also== | ==See Also== | ||
Revision as of 03:20, 11 August 2015
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)
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
Differential Diagnosis
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.