Approach to hyperthyroidism Andrew Maclennan, MD Morning Report 5/18/2010

Symptoms & Signs of Hyperthyroidism Anxiety Emotional lability Weakness Tremor Palpitations Heat intolerance Increased perspiration Weight loss despite a normal or increased appetite Hyperactivity Rapid speech Lid retraction Warm & moist skin Thin hair Tachycardia Hypertension Tremor Prox muscle weakness Hyperreflexia Specific to Graves: Proptosis Periorbital edema Pretibial myxedema

Hypothalamic-Pituitary-Thyroid Axis TSH Mediated Pituitary adenoma ( HCG disease) Exogenous Intake Ectopic Production Struma ovarii Metastatic follicular CA Autonomous Production Graves’ Hashimoto TMG Toxic adenoma Subacute Thyroiditis Granulomatous Lymphocytic

Thyroid Physiology

Radioactive Iodine Uptake Radioactive iodine load given Percent radioactive iodine uptake measured at: 4 hr 24 hrs  normal uptake is between 15-35%. Normal uptake Increased uptake in woman with Graves’ disease Decreased uptake in woman with subacute granulomatous thyroiditis

References Physiology, 2nd Edition. Costanzo UpToDate Tufts University Online Open Courseware – Hyperthyroidism http://ocw.tufts.edu/Content/14/lecturenotes/265881