HYPERTHYROIDISM
Dr. Zara Khan
Objectives:
INTRODUCTION:
• Hyperthyroidism and thyrotoxicosis are used
interchangeably, however each refers to slightly different
conditions.
• Hyperthyroidism refers to over activity of the thyroid
gland, with resultant excessive secretion of thyroid
hormones.
• Thyrotoxicosis refers to the clinical manifestations
associated with elevated unbound thyroid hormone.
• Thyroid Storm refers to extreme manifestation of
thyrotoxicosis.
Classification:
• Subclinical hyperthyroidism:
• TSH low, FT4&FT3 normal.
• In Mild Subclinical hyperthyroidism, TSH levels
are between 0.1-0.4 mIU/L
• In Sever TSH level is below 0.1 mIU/L
Clinical hyperthyroidism:
• TSH low, F4&FT3 high.
CAUSES:
• Primary hyperthyroidism
• (TSH low, High FT4 & FT3)
• Graves' disease
• Multinodular toxic goiter
• Autonomous toxic adenoma
• Iodine overload
• Stroma Ovarii
• Secondary hyperthyroidism
• (TSH High, High FT4 & FT3)
• TSH-producing pituitary adenoma
• Gestational thyrotoxicosis
• hCG-secreting Trophoblastic Tumors & Testicular
Choriocarcinoma
• Thyrotoxicosis without
Hyperthyroidism:
• Subacute Thyroiditis
• Silent Thyroiditis
• Radiation
• Amiodarone
• Exogenous/Thyrotoxicosis Faciata
Diagnosis:
• 1) Biochemistry:
• Serum TSH
• Serum T3, T4 Thyroid Imaging:
• 2) Serology: •USG Neck
• Thyroid Antibodies •Radioisotope Scan
• TRab -using either iodine 123
• TgAb or Technetium 99.
• TPOAb
Grave’s Disease
• Thyroid disease of autoimmune origin.
•Hyperthyroidism results from circulation of
antibodies known as thyrotropin-stimulating
immunoglobulins (TSIs) or Thyrotropin
receptor antibodies (TRAb).
INCIDENCE:
• Common in Women then Men (8:1)
• Usual Onset is between the ages of 20 &
40 years
TRIGGERING FACTORS & RISKS OF
OTHER AUTOIMMUNE DISEASES:
• Dietary iodine
supplementation • Sjögren syndrome,
• Potassium iodide or • Celiac disease,
amiodarone • Pernicious anemia,
• Chemotherapy with • Addison disease,
ipilimumab, • Alopecia areata,
pembrolizumab, • Vitiligo,
tremelimumab, and • Type 1 diabetes mellitus,
atezoli-zumab) and • Hypoparathyroidism,
alemtuzumab (for • Myasthenia gravis, and
multiple sclerosis) • Cardiomyopathy.
LABORATORY EVALUATION
In Graves disease, the TSH level is suppressed, and
total and unbound thyroid hormone levels are
increased.
* Measurement of TPO antibodies or TRAb (TSH
receptor antibody) may be useful if the diagnosis is
unclear clinically but is not needed routinely.
* Microcytic anemia and thrombocytopenia may occur.
Nonspecific laboratory findings.
-low serum total, LDL, and (HDL) cholesterol
concentrations
• normochromic, normocytic anemia
•Serum alkaline phosphatase I
Toxic Multinodular Goiter (Plummer
Disease) and Thyroid Nodules:
•Autonomous hyperfunctioning thyroid nodules
•They are more prevalent among older adults and in
iodine-deficient regions.
•Thyroid cancer is found in 5% of patients with toxic
multinodular goiter.
C. Autoimmune (Postpartum or Silent)
Thyroiditis and Subacute Thyroiditis
• These conditions cause thyroid
inflammation with release of stored
hormone
• They all produce a variable triphasic
course: variable hyperthyroidism is
followed by transient euthyroidism and
progression to hypothyroidism
Treatment:
