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Hyperthyroidism Clinical Applications

Hyperthyroidism Clinical Applications. Gail Nunlee-Bland, M.D. Division of Endocrinology. Hyperthyroidsim. Clinical condition resulting from overactivity of the thyroid gland an an excess of circulating thyroid hormone. Hyperthyroidism Causes. 2 categories Sustained hormone overproduction

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Hyperthyroidism Clinical Applications

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  1. Hyperthyroidism Clinical Applications Gail Nunlee-Bland, M.D. Division of Endocrinology

  2. Hyperthyroidsim • Clinical condition resulting from overactivity of the thyroid gland an an excess of circulating thyroid hormone

  3. HyperthyroidismCauses • 2 categories • Sustained hormone overproduction • No associated overproduction

  4. HyperthyroidismOverproduction • Graves’ disease • Toxic multinodular goiter • Toxic adenoma • Iodine-induced • Increase TSH secretion

  5. HyperthyroidismNo Sustained Overproduction • Thyrotoxicosis factitia • Subacute thyroiditis • chronic thyroiditis with transient thyrotoxicosis (painless thyroiditis, silent thyroiditis, post-partum thyroiditis • Ectopic thyroidtissue (struma ovarii, functioning metastatic thyroid cancer)

  6. Graves’Disease • Diffuse goiter • Thyrotoxicosis • Infiltrative orbitopathy • Infiltrative dermopathy

  7. Graves’ Disease • Autoimmune • Antibodies against thyroid peroxidase, thyroglobulin and the TSH receptor • Associated with other autoimmune disorders

  8. Graves’ Disease • Prevalence ~ 2.7% • Incidence 1 case 1000/yr • Most common cause of spontaneous hyperthyroidism in patients younger than age 40

  9. Organ Specific Effects of Graves’ Disease • Eyes • Infiltrative orbitopathy • Skin • Dermopathy

  10. Clinical ManifestationsThyrotoxicosis

  11. Clinical ManifestationsThyrotoxicosis

  12. Clinical ManifestationsThyrotoxicosis

  13. Toxic Multinodular Goiter • Generally seen in the elderly • Multiple nodules are felt on exam - few of the nodules may be hyperfunctioning on thyroid uptake scan • Signs and symptoms of hyperthyroidism are less pronounced • Less increase in thyroid hormone overproduction

  14. Toxic Adenoma • Hyperfunctioning solitary nodule • Occurs in a younger age group 30s or 40s • Long-standing slowly growing lump in neck • Manifestations of hyperthyroidism - less severe than in Graves’ disease • Uptake scan may show hyperfunctioning nodule

  15. Transient Hyperthyroidism • Subacute thyroiditis • thyroid pain • Elevated sedimentation rate • Silent thyroiditis • no thyroid pain • Postpartum thyroiditis • Factitious hyperthyroidism • ingestion of thyroid hormone • Decreased iodide uptake on thyroid scan

  16. Laboratory Investigations • TSH • Free T4 • T3RIA • Thyroid antibodies • Thyroid stimulating immunoglobulins • Thyroid uptake scan

  17. Euthyroid T4 TBG Resin

  18. Hyperthyroid T4 T3RU  TSH  TBG Resin

  19. Increase Uptake Scan • Hyperthyroidism • Iodine deficiency

  20. Decrease Uptake Scan • Subacute thyroiditis • Factitious thyroiditis • Antithyroid agents

  21. Treatment • Antithyroid drugs • Propylthiouracil • Methimazole • Beta blockers • Surgery • Radioactive iodine

  22. Thank You

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