PATHOPHYSIOLOGY OF HYPERTHYROIDISM

Regulation of Thyroid Hormones

↓ T3, T4, calcitonin levels

hypothalamus

thyroid releasing hormone

anterior pituitary gland

thyroid stimulating hormone

thyroid gland (TSH receptors)

↑T3, T4, and calcitonin levels

peripheral circulation
In cases of hyperthyroidism,

Thyroid stimulators in Destructive changes in (Grave’s disease) ↑ iodine intake

the blood the thyroid gland Autoantibody against ↓
↓ ↓ thyroid receptor for TSH ↑ formation of MIT
↑ secretion of thyroid Excessive release of ↓ and DIT
hormones thyroid hormone Continuous synthesis ↓
without ↑ synthesis and secretion of excess Coupling of MIT and
T3 and T4 DIT
↓
↑ formation OF T3 and
T4
s/s: goiter

↓
diffuse into peripheral circulation

participate in metabolic activity

*T4 – converted into T3

*T3 – only metabolically active; acts by binding to nuclear receptors

*Calcitonin -

regulation of transcription of various cellular proteins is disrupted

↑ basal metabolic rate Altered CHON, CHO, Stimulation of bone and ↑ sympathetic activity
↓ and fat metabolism bone marrow functions and CNS function
s/s: ↓ ↓ ↓
heat intolerance s/s: Bone resorption of s/s:
↑ body temperature (-) nitrogen balance calcium ↑ PR and RR
diaphoresis lipid depletion ↓ hypertension
muscle wasting / Hypocalcemia dyspnea
weight loss ↓ irritability
s/s: fine tremors
nausea, vomiting, nervousness
diarrhea
muscle atrophy
muscle spasm
In cases of thyroid storm/crisis,

Precipitating factors:

 Stress
 Infection
 Inadequate preparation for thyroid surgery
 Abrupt withdrawal of antithyroid medications

(Release of Infection When thyroid gland is Abrupt withdrawal of

catecholamines during ↓ vigorously palpated antithyroid medications
stress) Decreases serum during examination or is ↓
binding of T4 manipulated during Rebound
Sympathetic nerves ↓ surgery hyperthyroidism
innervate the thyroid Increase in free T4 ↓ ↓
gland and Hormone levels may
catecholamines rise rapidly Rapid synthesis and
stimulate thyroid secretion of hormones
hormone synthesis
↓
↑ density of beta-
adrenergic receptors
↓
Enhanced effect of
catecholamines

↓
exacerbation/exaggerated s/s of hyperthyroidism