Understanding Hyperthyroidism Symptoms
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ScribdTranslationsUnderstanding Hyperthyroidism Symptoms
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ScribdTranslationsUniversity of Carabobo
Faculty of Health Sciences
Comprehensive Clinical Department of the Llanos
Medical and Therapeutic Clinic II
San Carlos–State of Cojedes
Dr. José M. Fernández. Marelli Lake.
Anatomy. THYROID
From the Greek word
Tireos, SHIELD, and
Eidos, FORM.
In front of the trachea
between the cartilage
cricoid and the notch
suprasternal
The thyroid secretes 2
hormonas: TIROXINA
T4 Y
TRIYODOTHYRONINE
T3.
Functions of Hormones
Thyroid.
Accelerate the Indispensable
metabolism and the
Hormones for the
protein synthesis. Thyroid. growth.
Gastrointestinal Function:
induce an increase in the
Metabolic Index:
motility and the
accelerates metabolism
secretions
of all the tissues
gastrointestinal
corporal. Cardiovascular Function:
Determine an increase The acceleration of
of the consumption of
metabolism leads to a Effects
glucose, fats and increase in consumption of Neuromuscular:
proteins. oxygen and the production of Exerts effects
metabolic products pronounced about the
finals. nervous control of the
Increase the frequency and the function and tone
cardiac contractility for muscular.
to be able to maintain the volume
minuto necesario.
Hyperthyroidism.
Define thyrotoxicosis
as the excess of hormones
thyroid.
Hipertiroidismoes el
result of an excess of the
thyroid function.
Manifestations
Clinics.
General. Ocular.
Skin and appendages.
Retraction
Weight loss with Hot skin and palpebral
increased appetite humid, sweating and look of
fine tremor in heat intolerance astonishment.
hands. fine and fragile hair,
onycholysis, itching.
Manifestations
Clinics.
Cardiovascular Gastrointestinal
r. .
Nervous.
Tachycardia,
palpitations Hyperactivity, Increase of the
atrial fibrillation irritability frequency of
insufficiency nervousness, evacuations.
cardiac. anxiety and insomnia.
Manifestations
Clinics.
Skeletal muscle.
Gynecological
Hyperreflexia, atrophy
muscular, myopathy
Oligomenorrhea or
proximal
amenorrhea, loss of
osteoporosis.
libido
Hyperthyroidism.
SYMPTOMS SIGNS
Hyperactivity Tachycardia,
irritability, dysphoria, atrial fibrillation
in the elderly.
Heat intolerance. Tremors.
Palpitations. Goiter.
Fatigue and weakness. Dry and moist skin.
Weight loss with Muscle weakness,
increased appetite. proximal myopathy.
Diarrhea. Eyelid retraction
or palpebral response
ribbon.
Polyuria. Gynecomastia.
Dysmenorrhea.
Causes.
A.-WITH ELEVATED IODINE UPTAKE
Graves' disease
2. TOXIC THYROID ADENOMA
3. TOXIC MULTINODULAR GOITER
4. hCG-MEDIATED HYPERTHYROIDISM (mole)
["hydatidiform","choriocarcinoma","hyperemesis"]
gravidida, embryonal carcinoma of the testis
5. others
Causes.
B. with decreased or absent iodine uptake
Subacute thyroiditis
2. Fictitious Thyrotoxicosis
3. Excessive intake of thyroid hormone
[Link] follicular thyroid cancer
5. For consumption of hamburgers
6. Others
Graves-Basedow disease.
Graves' disease is a Clinical Picture.
autoimmune disease, caused by
autoantibodies against the receptor of
thyrotropin (anti-TSHR).
Hyperthyroidism.
These autoantibodies produce Diffuse goiter.
permanent activation of the receptor, Ophthalmopathy.
stimulation of synthesis and secretion Myxedema
of thyroid hormones, and growth Pretibial.
diffuse thyroid gland.
Graves' disease causes 60-80% of the
thyrotoxicosis.
Graves' disease affects 2% of the
women.
In women, it is 5-10 times greater than in
men.
It usually occurs between the ages of 20 and 50.
Disease of
Graves.
Symptoms and signs.
Determination: Free T4 (increased)
TSH (decreased)
T3 (suspicion of thyrotoxicosis)
The general laboratory tests:
hypocholesterolemia, moderate increase of the
VSG, discrete leukopenia and anemia, as well as
moderate hypercalcemia.
Determination of anti-TSH receptor antibodies confirms the
diagnosis
Thyroid antibodies (thyroid peroxidase and
antithyroglobulin
Toxic Adenoma or
Hyperfunctional Solitary Nodule.
It is an Autonomous nodule, and
produce quantities
excessive hormones
thyroid, what suppresses it
secretion of TSH.
Thyrotoxicosis is usually mild.
More frequent in people over 40 years old.
The presence of the thyroid nodule is the
large enough to be
palpable.
Thyroid scintigraphy provides
the diagnostic test: Nodule
Hot.
Toxic Multinodular Goiter
Plummer's disease.
It is characterized by the presence of
thyroid nodules
hyperfunctioning. Gammagraphy: uptake
It consists of mild thyrotoxicosis. heterogeneity with
The recent exposure to iodine in multiple regions of
contrast media can increased capture and
trigger or exacerbate the reduced.
thyrotoxicosis.
The TSH level is low.
Increased T3 and T4.
The remission of hyperthyroidism is possible
toxic multinodular goiter, due to necrosis or
hemorrhage from active nodules, this
the possibility is minimal.
Favorable if the diagnosis is established
prematurely and the treatment is carried out
opportune.
Otherwise, it remains overshadowed.
notably for thyrotoxic heart disease
Well, given the average age at which it appears
toxic multinodular goiter.
Treatment of choice: subtotal thyroidectomy
bilateral The patient must arrive euthyroid at
surgical act.
The treatment with 131I may have its
indication in elderly people or in
those that present contraindications for the
surgery. Dose: 80-100 mCi
Subacute Thyroiditis.
Also called De Quervain's Thyroiditis,
GRANULOMATOUS THYROIDITIS or VIRAL THYROIDITIS.
Manifestations
It has been related to
numerous viruses among them: Clinics.
mumps virus, virus
coxsackie, flu virus, Painful and enlarged thyroid
adenovirus. of size.
The maximum incidence occurs Occasional fever.
between 30-50 years old. There may be demonstrations
of thyrotoxicosis or
The thyroid gland presents a hypothyroidism.
inflammatory infiltrate with alteration of Discomfort and symptoms of the airways
the thyroid follicles, the changes lower respiratory.
follicles advance to the formation of The pain is often referred to the
granulomas accompanied by fibrosis. lower jaw or the ear.
Finally, the thyroid recovers several Exploration reveals a small
months later. painful nodule.
In the thyrotoxic phase: T3 and T4 (increased)
TSH is suppressed.
The T4/T3 index is higher than in the disease of
Graves or in the autonomous secretion of hormones
thyroid
The diagnosis is confirmed with the elevation of the
ESR and the low uptake of radioactive iodine (<5%)
The white blood cell count may be elevated.
Thyroid antibodies are negative
FNA biopsy
Acetylsalicylic acid (e.g., 600 mg every 4 to 6 hours) or
non-steroidal anti-inflammatory drugs
Glucocorticoids: initial dose is 40 to 60 mg
of prednisone. It is gradually reduced
for six to eight weeks
Thyroid function should be monitored every two to
four weeks with TSH concentrations
and of free T4.
The symptoms of thyrotoxicosis improve
spontaneously
Differential diagnosis of
hyperthyroidism.
Type of Goiter Diagnosis
Painless diffuse goiter. Graves' disease.
Thyroid nodules Multinodular goiter
multiple. toxic.
Single thyroid nodule. Thyroid adenoma.
Painful goiter and Subacute thyroiditis.
sensible.
Thyroid gland Graves' disease.
normal
Disease of
Graves.
Thyrotoxic Crisis or
Thyroid Storm.
It is uncommon, consisting of an exacerbation of
hyperthyroidism.
It usually triggers
Clinic: for illnesses
agudas
Attached:
Fever.
Cerebral accident
Vomiting.
vascular.
Diarrhea.
Infection.
Tachycardia.
Trauma.
Delirium.
Diabetic Ketoacidosis.
Seizures.
Surgery.
Comma.
For the assessment of thyrotoxicosis, an additive numerical scale is established.
according to the signs and symptoms of the patient. The result divides the subjects into
euthyroid (< 11 points), hyperthyroid (> 19 points) and doubtful (between 11 and 19 points)
points).
Diagnosis.
Clinical History: interrogation
Physical examination: clinic: fine tremor in hands. Skin
hot and humid, diaphoresis, tachycardia, muscle atrophy
proximal myopathy. GOITER.
Elevated levels of T3 and T4 with decreased
TSH.
In Graves' disease presence of
thyroid-stimulating hormone receptor-stimulating antibodies.
Thyroid gammagraphy.
Treatment.
It involves reducing the synthesis of thyroid hormones:
Administering Antithyroid drugs.
TIONAMIDES: propylthiouracil, methimazole (carbimazole).
They inhibit the function of thyroid hormone, reducing oxidation and the
organization of iodide.
Propylthiouracil inhibits the deiodination of T4 to T3.
They also reduce the concentration of antithyroid antibodies by
mechanisms that are not known exactly.
Initial dose of methimazole: 10 to 20 mg every 8-12 hours.
Propylthiouracil 100 to 200 mg every 6-8 hours.
They should be gradually reduced.
Euthyroid state: 6-8 weeks.
LONG-ACTING BETABLOCKERS, propranolol 20-40 mg each
6 hours.
Treatment.
Radioactive Iodine
Therapeutic radiopharmaceutical.
The active substance is I-131 in the form of sodium iodide, it accumulates in
the thyroid gland disintegrates, causing irradiation
selective of the organ.
It emits radioactive particles capable of destroying follicular cells.
thyroid.
It can be used as initial treatment or for recurrences after a
attempt with antithyroid drugs.
The size and function of the thyroid decrease in 6-12 weeks.
The optimal iodine dose has not been successfully calculated.
radioactive that allows to reach the euthyroid state.
Recommended dose: varies between 185 MBq (megabecquerel), (5 µCi
microcurie) and 555 MBq (15 µCi).
Hypothyroidism can occur as a complication.
Treatment.
SURGERY:
Subtotal Thyroidectomy
It is an option in patients who relapse after treatment.
antithyroid.
It is recommended in young subjects when the goiter is very large.
Before the surgery, it is necessary to perform careful monitoring of the
thyrotoxicosis with antithyroid medication to prevent a thyrotoxic crisis.
Indicated in bulky goiters and pregnant women who do not tolerate.
tionamidas.
Complications: hemorrhage, laryngeal edema, hypoparathyroidism and
injury of the recurrent laryngeal nerves.
Treatment.
THYROTOXIC CRISIS OR THYROID STORM
Intensive surveillance
IDENTIFICATION AND TREATMENT OF THE CAUSE
TRIGGER.
Administer high doses of propylthiouracil 600 mg in doses of
load and 200-300 mg every 6 hours, orally.
One hour after the first administration of propylthiouracil
stable iodide is administered (to block hormone synthesis
thyroid.
Propanolol 40-60 mg orally every 4 hours or 2 mg IV every 4.
hours.
