Overview
Thyrotoxicosis refers to hyperactivity of the thyroid gland, with increased circulating thyroid hormones. This tends to be accompanied by typical signs and symptoms of thyrotoxicosis such as those listed below.
Pathogenesis
Causes of Thyrotoxicosis
Primary
- Grave's disease
- Toxic multinodular goitre
- Toxic nodule
- Thyroiditis - postviral, postpartum, lymphocytic
- Thyroxine - excess replacement, thyrotoxicosis factitia
- Drugs - amiodarone, iodine
- Pregnancy-related - hyperemesis gravidarum, hydatidiform mole
- Struma ovarii
- Congenital hyperthyroidism
Secondary
- TSH-secreting pituitary tumour
Manifestations
Clinical Features
Symptoms
- Weight loss despite increased appetite
- Hyperactivity / irritability
- Heat intolerance
- Tremor
- Sweating
- Palpitations
- Diarrhoea
- Amenorrhoea
- Alopecia
Signs
- Sinus tachycardia / atrial fibrillation
- Psychomotor agitation
- Fine tremor
- Warm skin
- Onycholysis
- Palmar erythema
- Muscle wasting / weakness
- Hyperreflexia
- Alopecia
- Gynaecomastia
Manifestations of Grave's
- Exophthalmos
- Proptosis
- Periorbital / lid swelling and chemosis
- Lid lag
- Diplopia, poor convergence, limited upward gaze
- Corneal ulcers (exposure keratitis)
- Decreased visual acuity (retinal and optic nerve oedema)
- Pretibial myxoedema
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