Thyrotoxicosis essentially for all students 1.pptx

You will learn all about thyrotoxicosis

1. Thyrotoxicosis Dr. Mohammad Fahim “Sharifi”

2. Thyrotoxicosis Is the clinical syndrome that results when tissues are exposed to high circulating levels of thyroid hormones. Is not synonymous with hyperthyroidism which is a state of excessive thyroid function. It results in generalized increase in metabolic process increased sensitivity to catecholamines.

3. Atypical presentations Marked muscle atrophy (proximal myopathy) Thyrotoxic periodic paralysis (sudden flaccid paralysis and hypokalemia ) Thyrocardiac disease manifestations ;Refractory atrial fibrillation or high output HF Some oldy with weight loss ,severe depression , slow afib Young women with Amenorrhea

4. Diagnosis Clinical suspicion (signs and symptoms) Thyroid function test ; TSH and FT4 and/or T3 in primary hyperthyroidism ; TSH and FT4 and/or T3 in secondary hyperthyroidism TSAB (TSI) specific for graves disease RAIU scan (thyroid scintigraphy) ;shows increased or decreased blood flow History of autoimmune disorder Thyroid palpation

5. Differential diagnosis Can mimic aspects of other disorders; panic attack ,pheochromocytoma ,malignancy (weight loss) Can be excluded by normal TSH Sick euthyroid syndrome ( low TSH and low FT4 ,T3) Familial dysalbuminemic hyperthyroxinemia (normal TSH and T3 rules it out)

6. Diffuse toxic goiter Most common form of thyrotoxicosis Syndrome involves 1 or more ; thyrotoxicosis,goiter,ophtalmopathy,dermopathy Autoimmune cause,familial predisposition Triggers; pregnancy, infection , sress,tobacco

7. Pathogenesis; T lymphycytes sensitized to thyroid antigens and stimulate b lymph to secret antibody ;thyroid stimulating antibody Cytokines from sensitised lymphocytes cause activation and proliferation of orbital fibroblasts and fats resulting in swollen muscles and diplopia and exophthalmos thyroid dermopathy and subperiosteal inflammation of phalanges may also involve above Increased sensitivity to catecholamines

8. Diagnosis and treatment Dec. TSH and increased T4 and T3 RAIU TSAB

9. Therapy Three methods available Antithyroid drugs; Useful in young patients with small glands Radiation Surgery; choice for very large glands or multinodular goiter , Malignant thyroid nodules , pregnant women, allergy to drugs. Beta Blockers; Propranolol 10 mg to 40 mg Q6H

10. Subacute silent thyroiditis Can have severe presentation after pregnancy Can be differentiated by RAIU uptake scan Treatment ; aspirin 600 mg Q6H or NSAID if inadequate then use Prednisone 15 to 40 mg Monitor function every 2 to 4 weeks Beta Blockers and No antithyroid medications

11. Acute Thyroiditis Due to suppurative infection Presents with thyroid pain and tenderness , fever , dysphagia , erythema ESR and WBC increased Normal thyroid function Antiobiotic therapy guided by gram stain

12. Amiodarone induced Thyrotoxicosis An antiarrhythmic drug with half life of 50 days Can be caused due to excess iodine or amiodarone induced thyroiditis; former occurred within 6 to 12 months and later within 2 to 3 years Iodine induced treated with methimazole and Beta Blocker Thyroid test with prednisone

13. Thyroid storm Literally decompensated state Risk factors include , 1.thyrotoxic patients who don’t get therapy,2.acute illness or stress Diagnosis is based on presence of an acute life threatening condition with organ dyfunction particularly neurologic or cardiac Triad of Hyperthermia , severe tachycardia and neurologic derangement

14. treatment Propranolol 2mg IV slow every 5 to 10 min up to 10 mg or 40 to 80 mg q6h PTU 250 mg q6h or if oral intolerated PTU 400 mg enema q6h or methimazole 60 mg q24h Sol. Potassium iodide 10 drops bid Supportive measures ,cooling blankets,acetaminophen and NO Aspirin Oxygen ,diuretic and digoxin for ODD cardiac manifests including Heart failure and atrial fibrillation

15. References Harrison principles of internal medicine Greenspans basic and clinical endocrinology Washington manual of medicine