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Hyperthyroidism

Hyperthyroidism. TRH –Thyrotropin-releasing hormone. Produced by Hypothalamus Release is pulsatile Downregulated by T 3 Travels through portal venous system to adenohypophysis Stimulates TSH formation. TSH – Thyroid-stimulating hormone. Produced by Adenohypophysis Upregulated by TRH

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Hyperthyroidism

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  1. Hyperthyroidism

  2. TRH –Thyrotropin-releasing hormone • Produced by Hypothalamus • Release is pulsatile • Downregulated by T3 • Travels through portal venous system to adenohypophysis • Stimulates TSH formation

  3. TSH – Thyroid-stimulating hormone • Produced by Adenohypophysis • Upregulated by TRH • Downregulated by T4, T3 • Travels through portal venous system to cavernous sinus, body. • Stimulates: • Iodine uptake • Growth of thyroid gland

  4. Thyroid Hormone • Majority of circulating hormone is T4 • 98.5% T4 • 1.5% T3 • Total Hormone load is influenced by serum binding proteins • Albumin 15% • Thyroid Binding Globulin 70% • Transthyretin 10%

  5. Hyperthyroidism • Primary hyperthyroidism • Secondary hyperthyroidism (TSH) • Tertiary hyperthyroidism (TRH)

  6. Hyperthyroidism • Normal Thyroid • Inactive Thyroid • Hyperactive Thyroid

  7. Hyperthyroidism • 1. Graves’ disease • Toxic multinodular goiter • Toxic adenoma

  8. Graves’ disease • Most common cause of thyrotoxicosis • Autoimmune condition with anti-TSH antibodies • Onset of disease may be related to severe stress which alters the immune response

  9. Graves’ disease Etiology: • Is most often seen in women 20-40 years of age • Toxic nodular goiter • Toxic adenomas • Subacute thyroiditis

  10. Graves’ disease - History • Weight loss • Increased appetite • Heat intolerance, increase sweating • Nervousness • Weakness • Increased bowel frequency • Menstrual abnormalities

  11. Graves’ disease – Clinical features • Warm, moist skin • Goiter • Sinus tachycardia or atrial fibrillation • Thyroid bruit • Tremor • Hyperactive reflexes

  12. Graves’ disease - Exophthalmos Proptosis and lid retraction results from: 1) lymphocytic infiltration 2) edema of the extraocular muscles

  13. Graves’ disease - Evaluation • Suppressed TSH • Elevated Total T4 • TRH • Increased free T3, T4 • Thyroglobulin • Antibodies: Anti-TSH

  14. Graves’ disease - Treatment 1. Beta blockers for symptoms 2. Thionamide medications • May re-establish euthyroidism in 6-8 weeks • 40% - 60% incidence of disease remission 3. Radioiodine ablation • 10% incidence of hypothyroidism at 1 year • 55% - 75% incidence of hypothyroidism at 10 years

  15. Graves’ disease - Treatment Surgery • Used for compressive symptoms • Hypothyroidism occurs in up to 70% of subtotal thyroidectomy patients • Pre-surgical stabilization with thionamide medications

  16. Hyperthyroidism - Treatment Antithyroid drugs: • Methimazole • Carbimazole • Propylthiouracil

  17. Complications Thyroid storm – extreme hyperthyroidism Symptoms include: high fever, dehydration, tachycardia high-output cardiac failure coma

  18. Complications Treatment of a thyroid storm: B-blocker (propranolol) Propylthiouracil (PTU) Iodine Cooling measures

  19. Toxic Adenoma Treatment Radioiodine Surgery Preferred for children and adolescents Preferred for very large nodules when high I131 doses needed

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