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Hyperthyroidism(overt and mild)
Manifestations and diagnosis
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
