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Hyperthyroidism (overt and mild). Manifestations and diagnosis. Graves ophthalmopathy. Graves ophthalmopathy. Graves disease. Localized myxedema of the toe. Thyrotoxic periodic paralysis. Figure 3 Thyrotoxic periodic paralysis pathophysiology hypothesis.
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Hyperthyroidism(overt and mild) Manifestations and diagnosis
Figure 3Thyrotoxic periodic paralysis pathophysiology hypothesis Maciel, R. M. B. et al. (2011) Novel etiopathophysiological aspects of thyrotoxic periodic paralysis Nat. Rev. Endocrinol. doi:10.1038/nrendo.2011.58
Symptoms of overt hyperthyroidism • Anxiety • Emotional lability • Weakness • Tremor • Palpitations • Heat intolerance • Increased perspiration • Weight loss despite a normal or increased appetite, gain weight • Hyperdefecation (not diarrhea) • Urinary frequency • Oligomenorrhea or amenorrhea • Gynecomastia • Erectile dysfunction Isolated symptoms and signs: • Unexplained weight loss • New onset atrial fibrillation Myopathy • Menstrual disorders • gynecomastia. • Osteoporosis • Hypercalcemia • Heart failure • Premature atrial contractions • shortness of breath • Deterioration in glycemic control in patients with previously diagnosed diabetes.
Signs of overt hyperthyroidism • Hyperactivity and rapid speech. • Lid retraction and lid lag • warm and moist skin • Thin and fine hair • Tachycardia • Atrial fibrillation • Systolic hypertension may be present • Hyperdynamicprecordium • Tremor • Proximal muscle weakness • Hyperreflexia Only in patients with Graves' disease: 1) Graves ophthalmopathy • Exophthalmos • Periorbital and conjunctival edema • Limitation of eye movement 2) pretibialmyxedema • Infiltrative dermopathy
Diagnosis Low serum TSH High serum T4 and or high serum T3
Mild (subclinical) hyperthyroidism Normal T4 and T3 Suppressed TSH
Subclinical hyperthyroidism • Mild to moderate iodine deficiency • Females • Smokers • Elderly Prevalence in the community in older than 55 yrears: 0.7%-12.4%
Differential diagnosis of subclinical hyperthyroidism • Central hypothyroidism • Nonthyroidal illness • Recovery from hyperthyroidism, including thyroiditis
Subclinical hyperthyroidism Increased risk of mortality : Small Increases with • Age • degree of TSH suppression