HYPERTHYROIDISM

Soumya Ranjan Parida

Basic B.Sc. Nursing 4th year

Sum Nursing College

Hyperthyroidism

Etiology :-

• Diffuse toxic goiter (Graves disease )

• Mc Cune Albright syndrome• Toxic uninodular goiter (Plummer disease )• Hyper functioning thyroid Ca• Thyrotoxicosis factitia• Subacute thyroiditis

• Acute suppurative thyroiditis

Graves disease

• Incidence :- It occurs in 1: 5000 children.

Peak at 11 – 15 years.

F :M 5 :1

• Etiology :-

Infiltration of thyroid gland with

lymphocytes & plasma cells.

CD4/Th- predominate in dense lymphoid

aggrgate.

CD8/Ts - predominate in low dense area.

Etiology

Activated beta lymphocytes, infiltrating the thyroid is higher than in peripheral blood.

CD4/Th activated beta cells

Plasma cells

TRSAb / TRBAb

TSH receptor

cAmp

Etiology

Ophthalmopathy :- Ab against thyroid & eye muscle Ag

TSH receptor

Eye muscle & orbital fibroblast

Glycosaminoglycans

Cytotoxic effects

Clinical manifestations

Manifestations of hyperthyroidism :-

Symptoms – • Hyperactivity, irritability,

• Altered mood, insomnia• Heat intolerance, increased sweating• Palpitations• Fatigue, weakness• Dyspnea

• Weight loss with increased appetite

• Pruritus• Increased stool frequency• Thirst & polyuria• Amenorrhea, loss of libido

Clinical manifestations

Manifestations of hyperthyroidism :-

Signs-• Sinus tacycardia • Atrial fibrillation

• High output heart failure• Fine tremor, hyperkinesis• Hyperreflexia• Warm, moist skin• Pamer erythema, onycholysis

• Hair loss

• Muscle weakness & wasting• Chorea, periodic paralysis

Clinical manifestations

Manifestations of Graves disease :-

• Diffuse goiter

• Ophthalmopathy – • Dalrymples sign• Von Graefe’s sign• Enroth’s sign• Gifford’s sign

• Stellwag’s sign

Clinical manifestations

Manifestations of Graves disease :-

• Conjunctival sign• Pupillary sign• Ocular mobility defects

• Exophthalmos• Exposure keratitis• Optic neuropathy• Localised dermopathy• Lymphoid hyperplasia

• Thyroid acropachy

Diagnosis

Lab findings :-

Hyperthyroidism –

T3, T4, TG ed ; TSH ed

Increased TBG levels –

T4 ed, T3 N - ed,

FT4,TSH - N

Familial dysalbuminemic hyperthyroxinemia –

T4 ed, T3 N - ed,

FT3,FT4,TSH - N

Functional thyroid nodule –

T3 - ed,

Diagnosis

Thyroid hormone unresponsiveness –

T4, T3, FT4, FT3 ed ;

TSH N - ed

Pit unresponsiveness toThyroid hormone -

TSH N- ed

TSH secreting pit tumor –

TSH ed alfa chain

Exogenous T4 –

FT4 ed,

TSH ed, TG ed

Treatment

Drugs :-

1. Propylthiouracil - ( PTU )

• Dose to dose less potent.• Highly plasma protein bound.• Less transferred across placenta, milk• Plasma T ½ is 1- 2 hour• Single dose acts for 4-8 hour

• No active metabolite• Multiple doses• Inhibit peripheral T4 T3

Treatment

2. Carbimazole –

• 3 times more potent• Less bound to plasms proteins• Large amount transferred across placenta• Plasma T ½ is 6 – 8 hour• Acts for 12 - 24 hour

• Methimazole is active metabolite• Single dose• Does not inhibit peripheral T4 T3

Treatment

Dose :-

• Propylthiouracil - ( PTU )

5 - 10 mg/kg/day TDS orally• Methimazole –

0.25 – 1.0 mg/kg/day OD orally• Propranolol –

0.5 – 2 mg/kg/day TDS orally

Clinical response in 2–3 weeks

Adequate control in 1–3 months

Duration – 5 years

Treatment

• Subtotal thyroidectomy –

ATD is given for 2-3 mo to obtain euthyroid

state. 5 drops of saturated solution of KI

dailyfor 2 wk

• Radioiodine – Safe in more than 10 years age

Pretreatment with ATD not necessary

ATD should be stopped a week before

starting RI

Propranolol & low dose ATD for 2-3 mo

Side effects

ATD – Transient leukopenia

Transient urticarial rash

Hypersensitivity

Agranulocytosis

Hepatitis

Lupus like syndrome

Glomerulonephritis

vasculitis

Side effects

• Subtotal thyroidectomy – Paralysis of vocal cord

Hypoparathyroidism

• Radioiodine –

Benign adenoma ( 0.6-1.9 % )

Hypothyroidism ( 10-20 % )

Congenital hyperthyroidism

Etiology : –• Transplacental passage of TRSAb • 2 % of infants are born to mothers with

graves disease• M : F - 1 : 1

Clinical features : - • PT /IUGR with goiter

• Restless, irritable,• Hyperactive,anxious• Microcephaly with ventricular enlargement• Eyes widely open, exophthalmos

Congenital hyperthyroidism

• Tachycardia, • Tachypnea, • Hyperthermia• Weight loss despite revenous appetite

• Jaundice, • HSM• Cardiac decompensation, • HT• Advanced bone age,

• Frontal bossing with triangular facies,• Craniosynostosis

Treatment

Drugs :-

• Propranolol –

1 – 2 mg/kg/day TDS orally

• PTU –

5 – 10 mg/kg/day TDS orally

• Lugol solution –

1 drop every 8 hr

Digitalization

Most cases remit in 3–4 mo

THANKS