HYPERTHYROIDISM

Thyrotoxicosis
 DEFINITION
• “Thyrotoxicosis is defined as the state of thyroid hormone excess and is not synonymous
with hyperthyroidism, which is the result of excessive thyroid function”

• The resulting elevation in levels of free thyroxine (FT4), free triiodothyronine (FT3), or both
leads to the hypermetabolic condition of thyrotoxicosis

• The major etiologies of thyrotoxicosis are hyperthyroidism caused by Graves’ disease, toxic
MNG, and toxic adenomas
 EPIDEMIOLOGY
• Graves’ disease accounts for 60–80% of thyrotoxicosis
• Toxic multinodular goiter (15-20% of thyrotoxicosis) occurs more frequently in regions of iodine deficiency

• Autoimmune thyroid disease occurs with the same frequency in Caucasians, Hispanics, and Asians but at lower rates in African
Americans

• All thyroid diseases occur more frequently in women than in men

• Graves autoimmune disease male-to-female ratio 1:5-10

• Male-to-female ratio toxic multinodular goiter and toxic adenoma is 1:2-4

• Peak incidence in people aged 20-40 years

ETIOLOGI
 DIAGNOSING
1. Anamnesis
• Gejala klinis (RPS)
• Riwayat Keluarga

2. Px. Fisik
• Melihat sign dari pasien
• Thyroid examination (membesar, kadang terdengar bruit)
• Ophthalmologic and dermatologic examination
3. Px. Lab
• The serum value of TSH is decreased and the measurements of free thyroxine (T4) or free
thyroxine index or free tri-iodothyronine (T3), or both, are raised

• Once thyrotoxicosis has been identified by laboratory values, the thyroid radioiodine uptake
and scan may be used to help distinguish the underlying aetiology

• The presence of raised serum concentrations of thyroperoxidase (TPO) antibodies indicates

an autoimmune thyroid disorder and a raised TSI value indicates Graves' disease
RAIU
 TATALAKSANA
• Farmakologi
1. Antithyroid drugs (Thionamides: propylthiouracil (PTU), methimazole, Carbimazole).
Decrease thyroid hormone synthesis. Also decrease serum TSI concentrations in patients
with Graves' disease

2. Other drugs: β blockers relieve symptoms such as tachycardia, tremor, and anxiety in
thyrotoxic patients.
3. High dose glucocorticoids may be used to inhibit conversion of T4 to T3 in patients with
thyroid storm
4. Radioactive iodine
• Treatment with 131I is effective for patients with hyperthyroidism due to Graves' disease or
toxic nodular goiter

• Data show that 80-90% will become euthyroid within 8 weeks after a single 131I dose
• Non Farmakologi
1. Thyroidectomy
A meta-analysis found that thyroidectomy cures hyperthyroidism in more than 90% of cases

The procedure bears almost no risk of death when carried out by experienced surgeons

However, thyroidectomy is complicated by recurrent laryngeal nerve injury or permanent

hypoparathyroidism in 1-2% of patients
Thionamides are used to restore euthyroidism before thyroidectomy to avoid more severe
thyrotoxicosis from leakage of thyroid hormone into the circulation at the time of surgery
To reduce operative and postoperative complications associated with anaesthesia and surgery
in thyrotoxic patients
 REFERENCE
• Harrisson’s Internal Medicine ed.19
• Endocrinology at a glance
• NCBI Diagnosis and Management Thyrotoxicosis