Hyperthyroidism

Notes
  • These are a group of disoders that are characterized by over-production of T4 and T3 hormones by thyroid gland.
  • Excessive thyroid hormones results in hypermetabolism (thyrotoxicosis)
  • Causes of hyperthyroidism include:

_Production of thyroid stimulating

  autoantibodies (Graves’ disease or toxic

  diffuse goiter).

_Toxic single or multinodular goiter.

_Toxic adenoma

_Thyroiditis (Hashimoto’s disease or      

   inflammation of thyroid gland)

_Overdose of thyroxine

Symptoms
  • Enlarged thyroid gland (goiter)
  • Irritability and anxiety
  • Insomnia
  • Palpitation
  • Bulging eyes
  • Eye irritation
  • Hair loss
  • Increased appetite
  • Weight loss
  • Heat intolerance
  • Hyperhidrosis (excessive sweating)
  • Oligomenorrhea (Reduced menstrual flow)
  • Fatigue
  • Stare
  • Increased bowel movement
  • Thinning of the skin
  • Tachycardia
  • Atrial arrhythmia
  • Hypertension
  • Muscle weakness
  • Hand tremor
  • Osteoporosis (after a long life with the disease)
Diagnosis
  • Physical examination
  • Thyroid function tests (elevated to normal T4 but suppressed TSH).
  • Anti-thyroid peroxidase (anti-TPO) antibody
  • Thyroid-stimulating immunoglobulin (TSI)
  • Fine needle aspirate and cytology
  • Neck /thoracic inlet X-ray
  • Ultrasound of thyroid gland
Management
  • Pharmacotherapy:

Either;

_Tabs Carbimazole 15-20mg TID x 3-4wks then 5-30mg daily to maintain euthyroid state.

_ Tabs Propranolol 20-80mg  TID  (to relief symptoms of hyperthyroidism)

Or;

_Tabs Propylthiouracil (PTU) up to a maximum dose of 100mg TID

 *A second-line drug to be used when:

     **Carbimazole or Methimazole has failed or there is allergy to them.

     **1st Trimester of pregnancy

 *However, PTU is known to cause severe hepatotoxicity, especially in young population hence its use is contra-indicated in children. 

_ Tabs Propranolol 20-80mg TID (to relief symptoms of hyperthyroidism)

 

If the above treatment is not responsive within a period of 12-24 months and the patient is above 35 yrs old and for female who have completed child birth, iodine therapy is introduced;

 

  • Radiotherapy;

_Na131I at a dose of 370 megabecquerels STAT

 

  • Surgery;

In case of;

_Failure of the above management.

_Young patients

_Presence of obstructive symptoms

_Pregnancy

_Patient requiring immediate resolution

   of hyperthyroid state.

 

*Complication of surgery include: hypothyroidism, infections, postoperative bleeding and vocal cord paralysis.

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