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Thyroid Disorders
 
 

Thyrotoxicosis

 
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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

Diagnosis

    • TFT Interpretation

    • Primary hyperthyroidism -  reduced TSH with elevated T4
    • Subclinical hyperthyroidism - reduced TSH with normal T4
    • Central hyperthyroidism - elevated TSH with elevated T4
  •  
    Read more about thyroid function tests
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