Complications and Prognosis - Sheryl Prognosis Hyperthyroidism often responds well to treatment and is rarely life threatening.

However, thyroid surgery or radioactive iodine usually will cause hypothyroidism. Thyroid hormone replacement is then required. Complications Thyroid crisis/storm Rare but potentially life-threatening form of thyrotoxicosis (10% mortality) Leads to sudden intensification of symptoms may result from untreated hyperthyroidism Signs and symptoms: fever, severe tachycardia, mental state changes (delirium, psychosis, confusion), GI symptoms (abdominal pain, diarrhea) Causes: stressful event eg. trauma/infection, radioiodine therapy Management: immediate hospitalization, IV fluids, beta-blockers, propylthiouracyl (PTU)

Complications of untreated/poorly managed hyperthyroidism - Cardiac complications Heart failure Atrial fibrillation: 25% - Thyroid eye disease leads to swelling of conjunctiva, light sensitivity, blurred vision, double vision, - Osteoporosis (if left untreated over very long time) - Increased risk of fetal abnormalities and miscarriage in pregnant women - Gynecomastia Complications of treatment - Radioactive iodine therapy causes hypothyroidism in 50-70% of cases and leads to a small increase in the risk of thyroid cancer - To treat hypothyroidism due to surgery or radioiodine therapy, lifelong thyroid hormone replacement therapy is needed. If too much is administered, hyperthyroidism will recur. If too little, symptoms of hypothyroidism (weight gain, lethargy, depression etc) will persist. Complications of surgery (thyroidectomy) - Hoarseness due to damage of recurrent laryngeal nerve which supplies the voicebox - Low calcium level due to damage to the parathyroid glands (located near the thyroid gland) -Hypothyroidism References Kumar and Clark 7e pp.987-91 http://www.nlm.nih.gov/medlineplus/ency/article/000358.htm