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Hyperthyroidism Clinical Applications

Hyperthyroidism is a clinical condition characterized by the overactivity of the thyroid gland and an excess of circulating thyroid hormone. Learn about its causes, manifestations, diagnostic investigations, and treatment options in this comprehensive guide by Dr. Gail Nunlee-Bland.

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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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