hyperthyroidism (overt and mild)
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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Hyperthyroidism(overt and mild)
Manifestations and diagnosis
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Graves ophthalmopathy
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Graves disease
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Localized myxedema of the toe
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Thyrotoxic periodic paralysis
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Figure 3 Thyrotoxic periodic paralysis pathophysiology hypothesis
Maciel, R. M. B. et al. (2011) Novel etiopathophysiological aspects of thyrotoxic periodic paralysisNat. Rev. Endocrinol. doi:10.1038/nrendo.2011.58
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Toxic MNG
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Toxic adenoma
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Subacute thyroiditis
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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.
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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• Hyperdynamic precordium• Tremor• Proximal muscle weakness• Hyperreflexia
Only in patients with Graves' disease:1) Graves ophthalmopathy
• Exophthalmos• Periorbital and conjunctival
edema• Limitation of eye movement
2) pretibial myxedema • Infiltrative dermopathy
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Diagnosis
Low serum TSHHigh serum T4 and or high serum T3
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Mild (subclinical) hyperthyroidism
Normal T4 and T3Suppressed TSH
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Subclinical hyperthyroidism
• Mild to moderate iodine deficiency• Females• Smokers• Elderly
Prevalence in the community in older than 55 yrears: 0.7%-12.4%
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Differential diagnosis of subclinical hyperthyroidism
• Central hypothyroidism
• Nonthyroidal illness
• Recovery from hyperthyroidism, including thyroiditis
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Subclinical hyperthyroidism
Increased risk of mortality :
Small Increases with »Age»degree of TSH suppression
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