| ID | 63 |
|---|---|
| Name | HYPERTHYROIDISM |
| Cause | |
| Signs Symptoms | |
| Diagnosis | Diagnosis: 1. Serum T3 & T4 estimation- usually elevated. TSH- reduced or unrecordable. 2. Protein bound iodine is increased. 3. Radioactive iodine uptake is increased. 4. TRHtest. 5. Serum cholesterol is decreased. 6. E.C.G shows different types of arrythmias. 7. Thyroid scanning. |
| Investigations | |
| Management | Management of Ophthalmopathy: 1. Reassurance 2. Methylcellulose eye drops- counter the gritty discomfort of dry eyes. 3. To reduce excessive lacrimation due to exce-ssive stimulation by sun & wind- tinted glasses or side shield attached spectacle can be used. 4. If corneal ulceration- lateral tersorrhaphy is done 5. If persistant diplopia- extraoccular muscle surgery is done. 6. If papilloedema, visual field defect or loss of visual field then treatment with prednisolone 60mg/day. If no significant improvement with 7-10 day therapy then orbital decompression is done. Management of Dermopathy: Pretibial myxoedema rarely requires treatment. If required- local injection of triamcinolone acetate or application of betamethasone ointment under occlusive dressings may be effective. |
| Introduction | Hyperthyroidism is the clinical syndrome which results from exposure of the body tissue to excess circulating levels of free thyroid hormones. Females are more affected than males. Grave’s disease is distinguished clinically from other forms of hyperthyroidism by the presence of diffuse thyroid enlargement, ophthalmopathy and rarely pretibial myxoedema. |
| History | |
| Etiology | |
| Clinical Features | Clinical features: Goitre- Diffuse ± bruit, nodular. Gastrointestinal- Weight loss despite normal or increased appetite, hyperdefaecation, diarrhoea and steatorrhoea, anorexia, vomiting. Cardiorespiratory- Palpitations, sinus tachycardia, atrial fibrillation, increased pulse pressure, ankle oedema in absence of cardiac failure, angina, cardiomyopathy & cardiac failure, dyspnoea on exertion, exacerbation of asthma. Neuromuscular- Nervousness, irritability, emotional lability, psychosis, tremor, hyper-reflexia, ill-sustained clonus, muscle weakness, proximal myopathy, bulbar myopathy, periodic paralysis. Dermatological- Increased sweating, pruritus, palmar erythema, spider naevi, onycholysis, alopecia, pigmentation, vitiligo, finger clubbing, pretibial myxoedema. Reproducitve- Amenorrhoea/oligomenorrhoea, infertility, spontaneous abortion, loss of libido, impotence. Ocular- Lid retraction, lid lag, grittiness, excessive lacrimation, chemosis, exophthalmos, corneal ulceration, ophthalmoplegia, diplopia, papilloedema, loss of visual acuity. Other- Heat intolerance, fatigue, apathy, gynaecomastia, lympha-denopathy, thirst. |
| Preventions | |
| Treatment | Treatments: The treatment of hyperthyroidism (thyrotoxicosis) depends on the underlying cause and may include antithyroid drugs, radioactive iodine therapy or surgery (subtotal thyroidectomy). A. Anthithyroid drugs (e.g Carbimazole): Indications- 1st episode in patients < 40 years. Contraindications- hypersensitivity, breast feeding Disadvantages/complications- > 50% relapse rate usually within 2 years of stopping drug. Carbimazole dosage: 0-3 weeks - 15mg 3 times daily 4-8 weeks - 10mg 3 times daily Maintenance - 5-20mg daily Duration of treatment- 18-24 months. B. Subtotal thyroidectomy: Indications - 1. Recurrent hyperthyroidism after course of antithyroid drugs in patients <40yrs. 2. Initial treatment in males with large goitres and in those with severe hyperthyroidism i.e total T3, > 9.0 nmol/1. 3. Poor drug compliance. Contraindication - Previous thyroid surgery, dependence upon voice e.g opera singer, lectuer. Disadvantages/complications - Transient hypocalcaemia (10%), Hypopara-thyroidism (1%), recurrent laryngeal nerve palsy (1%). C. Radioiodine: Indications - 1. Patients > 40 years. 2. Recurrence following surgery irrespective of age. 3. Other serious illness e.g multiple sclerosis irrespective of age. Contraindications- Pregnancy or planned pregnancy within 6 months of treatment. Disadvantages/complications- Hypothyroidism, approximately 40% in 1st year, 80% after 15 years. D. Beta-adrenoceptor antagonists: Beta-adrenoceptor antagonist such as propranolol 160mg daily (40mg 6-hourly) or nadolol 40-80mg daily may be given. Some of the toxic manifestations of thyrotoxicosis are most rapidly (within 24-48 hours) reversed by this drug but can not be recommended for long term treatment. |
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