-IBIS-1.5.0-
tx
endocrine system
hyperthyroidism
diagnoses

definition and etiology

definition: A disease of hyperthyroidism combined with one or more of the following: pretibial myxedema, exophthalmos, and goiter. Also termed "toxic diffuse goiter" and "Grave's Disease".

etiology: Grave's disease: the classic cause of hyperthyroidism: is seen most in women aged 20-40. The cause is unknown although there might be an autoimmune connection, as in about 20-50% of patients there are circulating "long-acting thyroid stimulators" (LATS), which appear to be antibodies to the thyroid tissue.

signs and symptoms

signs and symptoms of general hyperthyroidism:
• Goiter.
• Tachycardia.
• Warm, fine, moist skin.
• Tremor.
• Atrial fibrillation; widened pulse pressure.

frequent symptoms:
• Nervousness and hyperactivity.
• Increased perspiration; worse heat.
• Palpitations; tachycardia.
• Weight loss; increased appetite.
• Insomnia; fatigue; weakness.
• Increased bowel movements.
• Exophthalmos; blurred and double vision.
• Myopathy: often involving the shoulder.
• Infiltrative dermopathy (aka pretibial myxedema): red and very itchy lesion.

lab findings:
• Increased serum T3 and resin uptake.
• Serum total thyroxine (T4) increased.
• Serum thyroxine-binding globulin is normal.
• Increased radioactive iodine uptake.
• Decreased serum cholesterol and lipids.
• Abnormal liver tests.
• Decreased TSH.
• Specific antibody testing to differentiate Grave's Disease and thyroiditis.

course and prognosis

Prognosis is variable: conventional treatments include iodine, antithyroid drugs, radioactive iodine, and surgery (which offers a very good prognosis).

differential diagnosis

• Thyroid storm.
• Toxic adenoma.
• Toxic multinodular goiter.
• Thyrotoxicosis factitia.
• Silent thyroiditis.
• T3 toxicosis.
• Anxiety states.
• Pheochromocytoma.


footnotes