Documentos de Académico
Documentos de Profesional
Documentos de Cultura
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Thyromegaly
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Hyperthyroidism
A hyper metabolic biochemical state
It is a multi system disease with
What is thyrotoxicosis ?
What is hyperthyroidism ?
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Causes of Hyperthyroidism
1.
2.
3.
4.
5.
6.
8.
9.
7.
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Graves Disease
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Graves Disease
Graves Disease
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Age
Graves disease
20 to 40
Toxic MNG
> 50 yrs
Any age
Sex M : F ratio
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Graves Disease
Toxic MNG
1: 5 to 1:10
1: 2 to 1: 4
Nucleotide Scintigraphy
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Clinical Features
1.
2.
3.
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Common Symptoms
1.
2.
3.
4.
5.
6.
7.
8.
9.
Nervousness
Anxiety
Increased perspiration
Heat intolerance
Tremor
Hyperactivity
Palpitations
Weight loss despite increased appetite
Reduction in menstrual flow or oligo-menorrhea
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Common Signs
1.
2.
3.
4.
5.
6.
7.
8.
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3.
1.
4.
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Clinical Presentations
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Toxic MNG
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(Diffuse) Graves
Thyroid Ophthalmopathy
Proptosis
Lid lag
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Ophthalmopathy in Graves
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Ophthalmopathy in Graves
Severe Exophthalmia
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Thyroid Dermopathy
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Graves Goiter
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Acropathy
Thyroid Acropathy
Clubbing and
Osteoarthropathy
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Onycholysis
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Hyperglycemia, Glycosuria
Osteoporosis and hypercalcemia
LDL and Total Cholesterols
Atrial fibrillation, LVH, LV EF
6.
7.
5.
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HIGH
NORMAL
PRIMARY
HYPERTHYROID
LOW
LOW
NORMAL
HIGH
HIGH
NORMAL
SUB CLINICAL
HYPERTHYROID
LOW
LOW
NORMAL
HIGH
Diagnosis
1.
2.
3.
4.
5.
6.
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TSH, FT4
Primary (T4)
Thyrotoxicosis
Measure FT3
TSH, FT4
N TSH, FT4 N
Pituitary Adenoma
FNAC, N Scan
Features of Graves
Yes
No
Rx. Graves
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RAIU
Low RAIU
High
T3 Toxicosis
Normal
Sub-clinical Hyper
F/u in 6-12 wks
Treatment Options
1.
2.
Methimazole, Carbimazole
Propylthiouracil (PTU)
3.
4.
5.
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Symptom Relief
Rehydration is the first step
blockers to decrease the sympathetic excess
1.
2.
3.
5.
6.
4.
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Methimazole
Propylthiouracil
Efficacy
Very potent
Potent
Duration of action
In pregnancy
Contraindicated
Mechanism of action
Iodination, Coupling
Iodination, Coupling
Conversion of T4 to T3
No action
Inhibits conversion
Adverse reactions
Dosage
20 to 40 mg/ OD PO
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Surgical Treatment
Subtotal Thyroidectomy, Total Thyroidectomy
Hemi Thyroidectomy with contra-lateral subtotal
1.
2.
3.
4.
5.
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Preoperative Preparation
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Dietary Advice
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Summary of
Hyperthyroidism
Hyperthyroidism
Age
Enlarged Pain
RAIU Treatment
Graves (TSI Ab
eye, dermo, bruit)
20 - 40
60% Diffuse
None
ATD 18 m
Toxic MNG
> 50
20% Lumpy
Pressure
RAI, Surgery
Single Adenoma
35 - 50
5%
None
RAI, ATD
Yes
NSAID, Ster.
Single
Thyrotoxicosis Factitia
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Normal TSH
TC 99 Nuclear Scan
Hot Nodule
RAI Ablation,
Surgery or
ATD
Cold Nodule
4%
Malignant
Surgery
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FNAC or US
guided biopsy
10%
69%
Suspicious or
follicular Ca
Benign
T4
suppression
Cyst
17%
Non diagnostic
repeat FNAC
Surgery or
Cytology
Case # 1
A patient complains of sandy sensation in his eyes,weight
loss, and a tremor. His extraocular muscles are inflammed.
His thyroid is diffusely enlarged and non tender.
The most likely diagnosis is
a. Iodine deficiency
b. Sub-acute thyroiditis
c. Multinodular goiter
d. Graves disease
e. Silent thyroiditis
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Case # 2
A 55 year old woman is anxious, irritable, frequent semi
solid stools and she reports weight loss of 5 kgs in the past
six months. She was having a lumpy bumpy painless
swelling in her neck for past 20 years.
The most likely diagnosis is
a. Iodine deficiency goiter
b. Sub-acute thyroiditis
c. Multinodular goiter
d. Graves disease
e. Solitary toxic adenoma
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Case # 3
A 60 year patient from a mountain region complains of
constipation. He has a heart rate of 60, dry thick skin,
and a tongue that has scalloped edges from teeth
indentation. He has a goiter.
The most likely diagnosis is
a. Iodine deficiency
b. Subacute thyroiditis
c. Graves disease
d. Silent thyroiditis
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Case # 4
A 25 year old woman is three months pregnant. She has
a large goiter. Her exam is otherwise normal. Her thyroid
tests are normal.
You recommend
a. Cassava five times weekly
b. Fish three times weekly
c. Formula milk for the baby when it is born
d. A very low salt diet
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Case # 5
A 72 year old man complains of tremor and inability to
concentrate. On exam, he has a heart rate of 100 beats
per minute. He has a large goiter with many nodules. He
has a fine tremor. His serum T4 is very high and TSH is
very low.
Treatments that are likely to improve his symptoms are
a. Iodine therapy
b. Ethanol injection of his thyroid (PEI)
c. 6 weeks of Methimazole
d. Radio Active Iodine therapy
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Case # 6
In Nuclear Scintigraphy Scan I123 uptake is very high in
the thyroid of patients with
a. Silent thyroiditis
b. Single functional adenoma
c. Sub-acute thyroiditis
d. Acute ingestion of animal thyroid extract
e. Graves disease
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