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

Maciel, R. M. B. et al. (2011) Novel etiopathophysiological aspects of thyrotoxic periodic paralysisNat. Rev. Endocrinol. doi:10.1038/nrendo.2011.58

Toxic MNG

Toxic adenoma

Subacute thyroiditis

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.

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

Diagnosis

Low serum TSHHigh serum T4 and or high serum T3

Mild (subclinical) hyperthyroidism

Normal T4 and T3Suppressed TSH

Subclinical hyperthyroidism

• Mild to moderate iodine deficiency• Females• Smokers• Elderly

Prevalence in the community in older than 55 yrears: 0.7%-12.4%

Differential diagnosis of subclinical hyperthyroidism

• Central hypothyroidism

• Nonthyroidal illness

• Recovery from hyperthyroidism, including thyroiditis

Subclinical hyperthyroidism

Increased risk of mortality :

Small Increases with »Age»degree of TSH suppression