Hyperthyroidism

• Facts:
  Thyroid overproduces thyroid hormone, causing thyrotoxicosis (increased levels of T3/T4 due to any cause)
  
  1.) Graves' disease
  2.) Toxic multinodular goiter (Plummer's disease)
  3.) Toxic adenomas
• History / PE:
  Weight loss, heat intolerance
  Nervousness, fine tremor
  Systolic HTN (hyperdynamic circulation)
  Palpitations, perspirations
  Tachycardia, AFib
  
• Diagnosis:
  Low TSH, increased T3 and T4
  Increased radioactive iodine uptake (RAIU)
• Treatment:
  Radioactive 131 Iodine thyroid ablation
  Propranolol (adrenergic symptoms)
  Methimazole (MMI) or propylthiouracil (PTU)
  Thyroidectomy (rarely indicated)
• Complications:
  Bone loss (untreated hyperthyroidism)
  Thyroid storm (afib, delirium , fever)
• Notes:
  Radioactive iodine destroys follicular cells, but dying cells may release excess thyroid hormone into circulation temporarily aggravating hyperthyroid state (thyrotoxicosis)
  
  Both MMI and PTU are associated with agranulocytosis
  Discontinue meds immediately if patient develops fever/sore throat and check WBCs
• Differential Diagnosis:
  1) Thyroiditis (reduced RAIU)
  2) Factitious thyrotoxicosis (low TSH, high T3/T4, history of psych disease or weight loss attempts, no exophthalmos/goiter) leads to follicular atrophy