Questions and Answers
What is the most common cause of hyperthyroidism?
Hyperthyroidism is the clinical effect of excess thyroid hormone secretion usually from gland hypofunction.
False
What is the definition of thyrotoxicosis factitia?
Excess exogenous L-thyroxine.
Thyrotoxicosis can be caused by excess _______________________ , as may occur in people taking certain expectorants or iodine-containing contrast agents for imaging studies.
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Match the following conditions with their corresponding causes of hyperthyroidism:
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What is the name of the disease that is a non-autoimmune disease of the elderly associated commonly with arrhythmia and CHF?
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Ectopic thyroid tissue is a extrathyroid source of hormones.
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What is the name of the antibody that stimulates the thyroid to secrete T4 and T3 in Graves' disease?
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What is the term for the painful inflammation of the thyroid gland that can cause transient hyperthyroidism?
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Hyperthyroidism can be caused by certain _______________________ , such as amiodarone, alpha interferon, and lithium.
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Study Notes
Indications of Hyperthyroidism
- Large thyroid gland
- Multiple symptoms of thyrotoxicosis
- High levels of thyroxine
- High titers of TSI
Treatment of Hyperthyroidism
- Radioactive iodine as first-line therapy, aiming to destroy the gland and induce hypothyroidism
- 3-Thyroidectomy (usually total), carrying a risk of damage to recurrent laryngeal nerve and hypoparathyroidism
- Subtotal thyroidectomy, indicated in pregnancy, children, and cases with compressive symptoms
Complications of Thyrotoxicosis
- Heart failure (thyrotoxic cardiomyopathy) and angina
- Osteoporosis
- Ophthalmopathy
- Gynaecomastia
- Thyroid storm
- Atrial fibrillation (seen in 10-25% of cases)
Subclinical Hyperthyroidism
- Defined as low TSH with normal T4 and T3
- Associated with a 41% increase in relative mortality from all causes
- Management involves confirming persistent suppressed TSH, ruling out non-thyroidal causes, and considering treatment if necessary
Skin Manifestations of Hyperthyroidism
- Excessive sweating and heat intolerance
- Warm and moist skin
- Palmar erythema, fine and silky hair
- Onycholysis (separation of finger nail from nail bed) and Plummer's nails
Ocular Signs of Hyperthyroidism
- Staring due to lid retraction
- Infrequent blinking
- Lid lag
Gastrointestinal Manifestations of Hyperthyroidism
- Frequent bowel movements
- Vomiting
- Weight loss despite increased appetite
Genital Manifestations of Hyperthyroidism
- Menstrual irregularity (oligomenorrhea) and infertility in women
- Decreased libido and erectile dysfunction in men
Signs of Graves' Disease
- Eye disease (exophthalmos, ophthalmoplegia)
- Pretibial myxoedema
- Thyroid acropachy
Diagnosis of Graves' Disease
- Made on history and physical exam
- Lab studies include decreased TSH, high serum free T4 and T3, elevated RAIU, and elevated TSI, antithyroglobulin, and antimicrosomal antibodies
Treatment of Graves' Disease
- Drugs: beta-blockers for rapid control of symptoms and antithyroid medications to control high thyroid hormones
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Description
This quiz covers the treatment options for Graves' disease, including antithyroid therapy and radioactive iodine, and their associated outcomes.
