39 HYPERTHYROIDISM General Discussion Hyperthyroidism is a hypermetabolic state that results from excess synthesis and release of thyroid hormone, usually from the thyroid gland. The overall incidence of subclinical and overt hyperthyroidism is estimated to be 0.05–0.1% in the general population. Hyperthyroidism occurs in all age groups and is more common in women than in men. Graves’ disease is the most common cause of hyperthyroidism, causing 60–80% of cases. However, toxic nodular goiter is the most common cause of hyperthyroidism in the elderly. Hyperthyroidism may present as a spectrum from asymptomatic, subclinical hyperthyroidism to life-threatening thyroid storm. Subclinical hyperthyroidism is diagnosed in asymptomatic patients with low thyroid stimulating hormone (TSH) but normal free T4 and free T3. Clinical hyperthyroidism presents with the typical signs and symptoms outlined below. Elderly patients often present a diagnostic challenge as they may present with lone symptoms or atypical presentations. They may present with negative symptoms such as depressive symptoms, lethargy, or apathetic facies. Elderly patients also may present with only a small goiter, weight loss, worsening of underlying cardiovascular disease, or new-onset atrial fibrillation. Medications Associated with Hyperthyroidism Amiodarone Campath 1-H monoclonal antibody Highly active antiretroviral therapy (HAART) Interferon-α Lithium Causes of Hyperthyroidism Factitious hyperthyroidism Graves’ disease Iodine-induced hyperthyroidism (iodine ingestion, radiographic contrast, amiodarone) Lymphocytic thyroiditis (Hashimoto’s thyroiditis) Medication-induced thyroiditis Metastatic thyroid cancer Ovarian tumors (struma ovarii) Pituitary adenoma secreting TSH Postpartum thyroiditis Toxic adenoma Toxic multinodular goiter Trophoblastic tumor Key Historical Features ✓ Constitutional symptoms • Anxiety • Excessive perspiration • Fatigue • Heat intolerance • Nervousness • Pruritis • Thirst • Weight loss ✓ Cardiac symptoms • Anginal symptoms • Exertional dyspnea • Orthopnea • Palpitations Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA HAIR LOSS INFERTILITY, MALE SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on HYPERTHYROIDISM Full access? Get Clinical Tree
39 HYPERTHYROIDISM General Discussion Hyperthyroidism is a hypermetabolic state that results from excess synthesis and release of thyroid hormone, usually from the thyroid gland. The overall incidence of subclinical and overt hyperthyroidism is estimated to be 0.05–0.1% in the general population. Hyperthyroidism occurs in all age groups and is more common in women than in men. Graves’ disease is the most common cause of hyperthyroidism, causing 60–80% of cases. However, toxic nodular goiter is the most common cause of hyperthyroidism in the elderly. Hyperthyroidism may present as a spectrum from asymptomatic, subclinical hyperthyroidism to life-threatening thyroid storm. Subclinical hyperthyroidism is diagnosed in asymptomatic patients with low thyroid stimulating hormone (TSH) but normal free T4 and free T3. Clinical hyperthyroidism presents with the typical signs and symptoms outlined below. Elderly patients often present a diagnostic challenge as they may present with lone symptoms or atypical presentations. They may present with negative symptoms such as depressive symptoms, lethargy, or apathetic facies. Elderly patients also may present with only a small goiter, weight loss, worsening of underlying cardiovascular disease, or new-onset atrial fibrillation. Medications Associated with Hyperthyroidism Amiodarone Campath 1-H monoclonal antibody Highly active antiretroviral therapy (HAART) Interferon-α Lithium Causes of Hyperthyroidism Factitious hyperthyroidism Graves’ disease Iodine-induced hyperthyroidism (iodine ingestion, radiographic contrast, amiodarone) Lymphocytic thyroiditis (Hashimoto’s thyroiditis) Medication-induced thyroiditis Metastatic thyroid cancer Ovarian tumors (struma ovarii) Pituitary adenoma secreting TSH Postpartum thyroiditis Toxic adenoma Toxic multinodular goiter Trophoblastic tumor Key Historical Features ✓ Constitutional symptoms • Anxiety • Excessive perspiration • Fatigue • Heat intolerance • Nervousness • Pruritis • Thirst • Weight loss ✓ Cardiac symptoms • Anginal symptoms • Exertional dyspnea • Orthopnea • Palpitations Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA HAIR LOSS INFERTILITY, MALE SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on HYPERTHYROIDISM Full access? Get Clinical Tree
