Hyperthyroidism

Chap 10. Unit VII

Introduction
• Hyperthyroidism is a set of disorders that involve
• Excess synthesis and secretion of thyroid hormones
• By the thyroid gland, which leads to the
• Hypermetabolic condition of thyrotoxicosis.

• Hyperthyroidism

• Thyrotoxicosis
Physiology Of Thyroid Hormones
Physiology Of Thyroid Hormones
Physiology Of Thyroid Hormones
• 93 % T4 and 7 % T3
• All most all T4 converts to T3 in body
• T3 four times more active.

• 1. BMR.
• Increases BMR
Physiology Of Thyroid Hormones
• 2. Protein Metabolism:
• Causes Transcription of DNA
• Translation of RNA
• Increases activity of Mitochondria
• Increases activity of Cellular enzymes.
• Increases synthesis of proteins
• Increases breakdown of proteins

3. CHO metabolism
• Increases glucose absorption and synthesis.
• Increases uptake into cells
• Glycogenolysis
Physiology Of Thyroid Hormones
• . Metabolism Of Fats:
• Fats mobilization
• Increases fatty acid level of Blood
• 5. Body Temp.
• Thermogenesis

• 6. Growth and development.

• fetal life
• Help in growth and development

• 7.Body weight.
Physiology Of Thyroid Hormones
8. CVS
• Erythropoiesis, HR, FC, BP

9. GIT
Increase peristalsis, increase appetiate

10. Respiratory system

Increase rate and depth of resp.

11. CNS.
Helps in brain development,
Active mind
Nervousness, Paronia, anxiety (Hyper T3 T4)
Somonolence Lethargy HypoSecreation
Physiology Of Thyroid Hormones
• 12. Sleep

• 13. Sexual system

• 14. Muscles
• Thyrotoxic myopathy
Classification of Hyperthyroidism
1. Abnormal Stimulation of Thyroid Gland
2. Thyroid Gland autonomy
• Increased Production of Thyroid Hormones
without TSH regulation.
• Hyperplastic and neoplastic conditions
• Solitary and multiple thyroid adenomas
• TSH decreases
• Genetic and environmental factors are involved
autonomous function.
• Iodine Intake?
3. Glandular Inflammation
• Inflammation as a result of
• infectious diseases
• Autoimmune processes
• Pharmacologic toxicity
• Can cause
• Thyrocyte death,
• Disruption of follicular architecture, and
• Unregulated leakage of thyroid hormones from the
gland into the circulation, resulting in thyrotoxicosis
3. Glandular Inflammation
Physical Examination
• Anxious, Hyperactive
• Pressured speech; tachycardia, systolic hypertension, and
• widened pulse pressure;
• velvety, warm, and moist skin; oily hair;
• staring gaze and lid lag;
• prominent systolic flow murmur;
• and proximal leg muscle weakness and tremor.
Clinical Presentation
• Weight loss despite good appetite,
• Heat intolerance,
• Tremor,
• Palpitations, and anxiety
• Fatigue, insomnia, dyspnea,
• and atypical chest pain.
Thyroid storm
• Thyroid storm is a life-threatening medical emergency
• Characterized by
• Severe thyrotoxicosis
• High fever (often >103◦F)
• Tachycardia
• Tachypnea
• Dehydration
• Delirium
• Coma, nausea, vomiting, and diarrhea.
• Precipitating factors?
Diagnosis

1. Physical Exam

2. TFTs

3. Thyroid Scan

4. Thyroid Biopsy
Differential Diagnosis
Management of Hyperthyroidism
Goal of Therapy
• Eliminate thyroid hormone and
• Minimize the symptoms and long-term consequences
of hyperthyroidism.
• Therapy must be individualized based on
• Type and severity of hyperthyroidism.
• Patient age and gender.
• Existence of nonthyroidal conditions, and
• Response to previous therapy
Hyperthyroidism Treatment Options

1. Anti 2. Radioactive 3. Surgery

Thyroid Iodine
Medications
Anti Thyroid Drugs

• May be Consider
• (1) temporary treatment of GD who are unwilling to accept RAI

• (2) for preliminary control of hyperthyroidism before definitive RAI or

surgery

• (3) Pregnancy and neonatal Graves disease

• (4) to determine whether nonspecific symptoms are in fact related to

mild thyrotoxicosis.
Anti Thyroid Drugs
• Thiourea Drugs
• PTU and MMI
• Thyroid peroxidase inhibitor
• Decreases Immune Response
• Decrease Peripheral conversion of T4 to T3 (PTU)
• MMI is approximately 10 times more potent than
PTU
• Remission rate 40-50 %
Anti Thyroid Drugs
• older patients
• Low ratio of T4 to T3
• Short duration of disease (<6 months),
• No previous history of relapse with ATDs
• Duration of therapy 1 to 2 years or longer, and low
TSAb titers at baseline or a reduction with treatment.
• Patients will be followed every 6 to 12 months after
remission occurs
• Require 3-8 weeks to become Euthyroid
Radioactive Iodine
• Drug of choice for GD and TNG
• Beta blockers may be given
• 60% of patients become euthyroid at 6 months or less.
• 40% become euthyroid within 1 year, requiring two or more
doses
• Second dose of RAI be given 6 months
• For example, in the United Kingdom, a nursery school teacher
is advised to stay out of school for 3 weeks following a 15-mCi
dose of I 131
• Require 1-2 months
Surgical Management
• Surgery should be
• Considered when Thyroid gland (>80 g)
• Severe ophthalmopathy.
• Lack of remission on antithyroid drug treatment.
THYROID STORM
Thyroiditis
• Patients with mild symptomatic thyroiditis should be
treated initially with
• b-adrenergic-blocking drugs and
• NSAIDs.
• Corticosteroids
• Levothyroxine
Hyperthyroidism Treatment algorithm