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Hyperthyroidism: - 60% Due To Grave's Disease - 40% Due To Miscellaneous Causes

Hyperthyroidism and hypothyroidism are caused by various conditions that result in excessive or insufficient thyroid hormone levels. The most common causes of hyperthyroidism are Grave's disease and toxic multinodular goiter, while Hashimoto's thyroiditis is the leading cause of hypothyroidism. Diagnosis involves measuring thyroid hormone levels, and treatments aim to control hormone levels through medications, radioactive iodine, or surgery.

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Leitavia D.
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178 views

Hyperthyroidism: - 60% Due To Grave's Disease - 40% Due To Miscellaneous Causes

Hyperthyroidism and hypothyroidism are caused by various conditions that result in excessive or insufficient thyroid hormone levels. The most common causes of hyperthyroidism are Grave's disease and toxic multinodular goiter, while Hashimoto's thyroiditis is the leading cause of hypothyroidism. Diagnosis involves measuring thyroid hormone levels, and treatments aim to control hormone levels through medications, radioactive iodine, or surgery.

Uploaded by

Leitavia D.
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Hyperthyroidism

• 60% due to Grave’s Disease


• 40% due to miscellaneous causes:
– Thyroiditis, toxic adenomas, TSH-secreting
pituitary tumors, struma ocarii, & hCG-secreting
tumors
• Diagnosis
– Increased T3 and T4
– Decreased TSH
• Except in TSH-secreting tumors
Hypothryoidism Causes
Etiology Clinical Manifestations
Grave’s Disease •TSI binds TSH receptor on •Diffuse nontender goiter
thyroid gland; leads to ↑ T3/T4 with bruit
(diffuse uptake on thyroid scan) •Infiltrative ophthalmopathy
•Associated w/ other (proptosis, extraocular
autoimmune disorders muscle dysfunction)
•Pretibial myxedema
Plummer’s Disease (toxic •Hyperfunctioning areas that •Less severe than Grave’s
multinodular goiter) make ↑ T3/T4 (patchy uptake •Associated w/ life-
on thyroid scan) threatening arrhythmias &
•More common in elderly CHF
Subacute Thyroiditis (de •Inflammation of thyroid •Thyroid gland firm, painful,
Quervain’s thyroiditis) glandspilling of thyroid tender
hormonetransient •Fever
hyperthyroidism •Increased ESR
•Usually preceded by upper •Pain radiating to ears, neck
respiratory infection & arm
Treatment
• Thionamides (PTU & methimazole) to inhibit thyroid hormone
synthesis; PTU also inhibits peripheral conversion of T4 to T3
– Mechanism: Inhibits oxidation & organification of iodine, a required step in
thyroid hormone synthesis
– Both cross the placenta & are contraindicated in pregnancy; PTU is used
during lactation
– Side effects=rash, urticaria, fever, nausea; major effects=agranulocytosis,
thrombocytopenia, acute hepatic necrosis & vasculitis
• β-Blockers (propanolol) to control the adrenergic symptoms
(sweating, tachycardia, tremor)
• Radioactive Iodine to destroy thyroid function
– Side effects=metallic taste, excessive salivation, diarrhea, rash
• Surgery
Signs & Sypmtoms
Hyperthyroidism Hypothyroidism

Symptoms Hyperactive, irritable Difficulty concentrating, Poor memory

Heat intolerance, sweating Cold intolerance

Palpitations Dyspnea

Fatigue, weakness, Insomnia Fatigue, weakness, lethargy

Diarrhea, polyuria Constipation

Oligomenorrhea, loss of libido Menorrhagia

Weight loss Weight gain, poor appetite

Impaired hearing, hoarse voice (deep voice)

Parasthesias

Tachycardia Bradycardia
Signs
Tremor Delayed Tendon reflex relaxation

Goiter Peripheral edema

Warm, moist skin Dry, coarse skin & Hair loss (Diffuse alopecia)

Proximal muscle weakness Carpal tunnel syndrome

Lid retraction, lid lag Puffy face, hands, & feet (myxedema)

Gynecomastia Diastolic Hypotension


Hypothyroidism
• 95% cases are 1°: Hashimoto’s thyroiditis, Riedel’s
thyroiditis, iodine deficiency, & surgical destruction
• 2° causes=failure of the pituitary gland
• 3° causes=failure of the hypothalamus
• Diagnosis
– T3/T4/TSH/TRH
• All are helpful to diagnose & distinguish among 1°, 2°, and 3° causes
– Antimicrosomal antibodies to test for Hashitmoto’s Thyroiditis
– Imaging of Pituitary & hypothalamus for tumor
Treatment
• Levothyroxine (T4) replacement
– Levothyroxine is a T4 analog that binds to nuclear
receptors. This leads to ↑ protein synthesis, ↑
metabolic rate,↑ β-receptorsincreased
sensitivity to catecholamines
– Side effects=signs & symptoms of hyperthyroidism
• Use emperic adrenal replacement therapy &
Liothyronine when myxedema coma is involved
– Liothyronine can precipitate heart failure

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