HYPERTHYROIDISM,clinical features and its management

management of hyperthyroidism

1. HYPERTHYROIDISM

2. DEFINITIONS: THYROTOXICOSIS: Clinical state that results from inappropiately high thyroid hormones action in tissues due to inappropiately high throid hormone levels. HYPERTHYROIDIDSM: A form of thyrotoxicosis due to inappropiately high synthesis and secretion of thyroid hormones by the thyroid.

3. CONFUSING TERMS:….. JOD BASEDOW DISEASE: Iodine induced hyperthyroididsm that may occur in patients with MNG after intake of large amount of iodine such as in diet,radiograhic contrast material, drugs like amiodarone . THYROTOXICOSIS FACTITIA: Thyrotoxicosis produced due to excessive amount of exogenous thyroid hormone.Epidemics of thyrotoxicosi caused by ground beef consumption with bovine thyroid gland.

4. WOLFF-CHIAKOFF EFFECT: Excess iodine transiently inhibits thyroid iodide organification.This phenomenon of iodine dependant transient supression of thyroid is called WOLLF-CHIAKOFF EFFECT.

5. EYE SIGNS: Exophthalmos – Unilateral or bilateral – Infiltration of retrobulbar tissue with fluid and round cells • Retraction/spasm of upper eyelid • Levator palpabre superiaris supplied partly by sympathetic fibers • Graves ophthalmopathy is autoimmune disease

6. • Diplopia –Extra occular muscle involvement.(IM SLOW) • Papilloedema and corneal ulcer • Malignant exophthalmos • Graves ophthalmopathy -autoimmune diseaseAb mediated effects on the ocular muscles

7. THYROID ACROPACHY Deposition of Mucin like substances in the subcutaneous tissues.

8. THYROID ACROPACHY

9. TOXIC NODULE • Solitary overactive nodule • Part of generalised nodularity or two toxic adenoma • Autonomous • TSH- suppressed by high T3 and T4 • Normal surrounding thyroid tissue – suppressed and inactive

10. LABORATORY INVESTIGATIONS: TSH has the highest sensitivity and speciffity . Diagnostic accuracy increases with the measurement of Free T4. Free T4 gives the baseline assessment of the initial treatment but does not always correlates with the severity.

11. RAIU

12. BURCH WARTOFSKY SCALE:

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