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

2. 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

3. 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

4. Thyroid Physiology

5. 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

8. References Physiology, 2nd Edition. Costanzo UpToDate
Tufts University Online Open Courseware – Hyperthyroidism