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Angat, Karizza Ann U.

BSN 3Y1-1/1A

Thyroidectomy  Removal of all or a portion of the thyroid gland.  The procedure is usually performed to treat various disease of the thyroid gland that may not be treated effectively by chemotherapy or medication.  A total thyroidectomy is indicated for certain carcinomas and to relieve tracheal or esophageal compression.  Although rare, may be performed for patients with thyroid cancer, hyperthyroidism, and drug reactions o antithyroid agents; pregnant women who cannot be managed with drugs; patients who do not want radiation therapy; and patients with large goiters who do not respond to antithyroid drugs. Two types of thyroidectomy include:  Total thyroidectomy:  The gland is removed completely. Usually done in the case of malignancy. Thyroid replacement therapy is necessary for life.  Subtotal thyroidectomy:  Up to five-sixths of the gland is removed when antithyroid drugs do not correct hyperthyroidism or RAI therapy is contraindicated. Hyperthyroidism: Hyperthyroidism presents with multiple symptoms that vary according to the age of the patient, duration of illness, magnitude of hormone excess, and presence of comorbid conditions. Symptoms are related to the thyroid hormone’s stimulation of catabolic enzymopathic activity and catabolism, and enhancement of sensitivity to catecholamines. Common symptoms with attention to the differences in clinical presentation between younger and older patients. Older patients often present with a paucity of classic signs and symptoms, which can make the diagnosis more difficult. Thyroid storm is a rare presentation of hyperthyroidism that may occur after a stressful illness in a patient with untreated or undertreated hyperthyroidism and is characterized by delirium, severe tachycardia, fever, vomiting, diarrhea, and dehydration.

or medications. exposure to radiographic contrast media. Amiodarone-induced Amiodarone.(Cordarone-) induced hyperthyroidism can be found in up to 12 percent of treated patients. TOXIC MULTINODULAR GOITER Toxic multinodular goiter causes 5 percent of the cases of hyperthyroidism in the United States and can be 10 times more common in iodine-deficient areas. and occurs by two mechanisms. Postpartum thyroiditis can occur in up to 5 to 10 percent of women in the first three to six months after delivery. TOXIC ADENOMA Toxic adenomas are autonomously functioning nodules that are found most commonly in younger patients and in iodine-deficient areas. Symptoms usually resolve within eight months. This condition can be recurrent in some patients. Excess iodine increases the synthesis and release of thyroid hormone in iodine-deficient patients and in older patients with preexisting multinodular goiters. active against the thyroidstimulating hormone (TSH) receptor. TREATMENT-INDUCED HYPERTHYRIODISM Iodine-induced Iodine-induced hyperthyroidism can occur after intake of excess iodine in the diet. may be clinically indistinguishable from Graves’ disease. accounting for 60 to 80 percent of all cases. An infiltrative ophthalmopathy accompanies Graves’ disease in about 50 percent of patients. THYROIDITIS Subacute Subacute thyroiditis produces an abrupt onset of thyrotoxic symptoms as hormone leaks from an inflamed gland. Because . It is an autoimmune disease caused by an antibody. A transient hypothyroidism often occurs before resolution. especially those in iodine-deficient areas.Etiology GRAVES’ DISEASE Graves’ disease is the most common cause of hyperthyroidism. in the acute stage. It can be familial and associated with other autoimmune diseases. It often follows a viral illness. which stimulates the gland to synthesize and secrete excess thyroid hormone. and has a more insidious onset than Graves’ disease. It typically occurs in patients older than 40 years with a long-standing goiter. Lymphocytic and Postpartum Lymphocytic thyroiditis and postpartum (subacute lymphocytic) thyroiditis are transient inflammatory causes of hyperthyroidism that.

TUMORS Rare causes of hyperthyroidism include metastatic thyroid cancer. Thyroid hormone-induced Factitial hyperthyroidism is caused by the intentional or accidental ingestion of excess amounts of thyroid hormone. trophoblastic tumors that produce human chorionic gonadotrophin and activate highly sensitive TSH receptors. ovarian tumors that produce thyroid hormone (struma ovarii).-secreting pituitary tumors. and TSH. Some patients may take thyroid preparations to achieve weight loss. type I is an iodine-induced hyperthyroidism (see above). Medications such as interferon and interleukin-2 (aldesleukin) also can cause type II. Amiodarone is the most common source of iodine excess in the United States. .amiodarone contains 37 percent iodine. Type II is a thyroiditis that occurs in patients with normal thyroid glands.

granulocytosis. Thyroid-stimulating antibody levels can be used to monitor the effects of treatment with antithyroid drugs in patients with Graves’ disease. . Nonspecific laboratory findings can occur in hyperthyroidism. including anemia. Further testing is warranted if the TSH level is abnormal. An undetectable TSH level is diagnostic of hyperthyroidism. and alkaline phosphatase elevation.Diagnosing Hyperthyroidism Measurement of the TSH level is the only initial test necessary in a patient with a possible diagnosis of hyperthyroidism without evidence of pituitary disease. lymphocytosis. transaminase elevations. Antithyroid antibodies are elevated in Graves’ disease and lymphocytic thyroiditis but usually are not necessary to make the diagnosis. hypercalcemia. Radionuclide uptake and scan easily distinguishes the high uptake of Graves’ disease from the low uptake of thyroiditis and provides other useful anatomic information.

2 percent). comorbid conditions. interferes with the antithyroid drugs are not response to radioactive iodine. Japan. methimazole can cause rare Treatment Beta blockers Iodides Antithyroid drugs (methimazole [Tapazole] and PTU) .Treatment The treatment of hyperthyroidism depends on the cause and severity of the disease.1 to 0. and disease. tolerated. release or contraindicated. first. PTU can Europe. and positive thyroid-stimulating block peripheral Australia). refuse radioactive iodine. or acneform pregnancy when rash. radioactive iodine.euthyroidism with antithyroid (Cordarone-) induced drugs hyperthyroidism Interferes with Long-term treatment of High relapse rate.5 percent). relapse more the Graves’ disease (preferred likely in smokers. during conjunctivitis. patients with organification of first-line treatment in large goiters. shortterm therapy in pregnancy Block the Rapid decrease in thyroid Paradoxical increases in conversion of hormone levels. chronic obstructive pulmonary radioactive iodine. or asthma antithyroid drugs. The goal of therapy is to correct the hypermetabolic state with the fewest side effects and the lowest incidence of hypothyroidism. goiter size. and patients with iodine. major side effects T4 toT3 in large patients who are pregnant include polyarthritis (1 to 2 doses and those with severe percent). Treatment of Hyperthyroidism Mechanism of action Inhibit adrenergic effects Contraindications and Indications complications Prompt control of Use with caution in older symptoms. and surgery are the main treatment options for persistent hyperthyroidism.1 Graves’ disease. common side inhibit hormone medications are ineffective effects of sialadenitis. preferred to 0. agranulocytosis (0. hormone release with T4 to T3 and preoperatively when other prolonged use. Antithyroid drugs. PTU is antibody levels at end of conversion of treatment of choice in therapy. and immunoallergic children and for adults who hepatitis (0. line therapy before surgery. PTU can cause treatment by many elevated liver enzymes (30 endocrinologists for percent). as well as on the patient’s age. Beta blockers and iodides are used as treatment adjuncts. Each therapy can produce satisfactory outcomes if properly used. treatment of patients and in patients with choice for thyroiditis.pre-existing heart disease. and treatment desires. with antithyroid prolongs the time to achieve drugs to treat amiodarone.

minor side effects (less than 5 percent) include rash. refuse radioactive iodine. toxic nodules in patients younger than 40 years. and decreased taste. multinodular goiter. and relapses from antithyroid drugs Surgery (subtotal thyroidectomy) Reduces thyroid Treatment of choice for mass patients who are pregnant and children who have had major adverse reactions to antithyroid drugs. can be used for patients who are noncompliant. treatment of thyroid tissue choice for Graves’ disease in the United States. radiation thyroiditis in 1 percent of patients. flushing. may exacerbate Graves’ ophthalmopathy. or fail antithyroid drugs. requires patient to be euthyroid preoperatively with antithyroid drugs or iodides to avoid thyrotoxic crisis . may be done for cosmetic reasons Contraindications and complications cholestasis and rare congenital abnormalities. temporary or permanent hypoparathyroidism orlaryngeal paralysis (less than 1 percent). both medications considered safe for use while breastfeeding Concentrates in High cure rates with the thyroid gland singledose treatment (80 and destroys percent). may require pretreatment with antithyroid drugs in older or cardiac patients Risk of hypothyroidism (25 percent) or hyperthyroid relapse (8 percent). contraindicated in patients who are pregnant or breastfeeding. and in patients with severe disease who could not tolerate recurrence. and arthralgia Delayed control of symptoms. posttreatment hypothyroidism in majority of patients with Graves’ disease regardless of dosage (82 percent after 25 years). and large goiters with compressive symptoms. can cause transient neck soreness. higher morbidity and cost than radioactive iodine. gastrointestinal effects.Treatment Mechanism of action Radioactive iodine Indications pretreatment of older and cardiac patients before radioactive iodine or surgery. toxic nodules in patients older than 40 years. fever.