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more about Thyrotoxicosis


  • The thyroid gland produces the thyroid hormones triiodothryronine (T3) and thryroxine (T4).  T3 is the more active form, while T4 is partially converted to T3 when released in the blood stream.  The thyroid hormones regulate metabolism throughout the body.  The pituitary gland releases a hormone (thyroid stimulating hormone) that controls the release of the hormones from the thyroid.  Graves' disease, which is the most common type of Hyperthyroidism, is associated with enlargement and dysfunction of the eye.  In addition, a heart arrythmia called atrial fibrillation may occur with Hyperthyroidism (President George Bush had this while in office)

  • Nervousness
  • Anxiety
  • Heat intolerance
  • Increased sweating
  • Fatigue
  • Sweating
  • Weight loss
  • Muscle Cramps
  • Diagnosis
  • Lid lag
  • Enlarged eye balls
  • Heart racing
  • Heart Palpitations
  • Moist warm skin
  • Hair loss
  • Thinning nails
  • Increased bowel movements

  • Examination:
    1. Ophthalmoplegia
    2. Increased pulse
    3. Irregular pulse
    4. Clubbing/swelling of fingers
    5. Bruit over thyroid gland
    6. Tremor
  • Laboratory:
    1. Blood tests T3, T4, thyroid resin uptake, and free Thyroxine are usually all increased.
    2. 3rd generation TSH is low
    3. Antimicrosomal or antithyroglobulin antibodies are usually elevated in Graves' disease
  • Radioactive iodine scan shows diffuse disease (thyroid uptake performed at same time to calculate dose of radioactive iodine that may be needed for treatment)
  • Sedimentation rate is usually increased in Subacute Thyroiditis
  • Imaging: MRI of orbits to evaluate extraocular eye muscles in Graves' disease

    • Medications:
      1. Propranolol treats the symptoms and decreases the conversion of T4 to T3
      2. Methimazole
      3. Propylthiouracil


  • Radioactive iodine (swallowed) -- this treatment can result in a permanent cure, but should not be given to pregnant women or those under 25 years old.  Lifetime thyroid supplementation after treatment is often needed.
  • Thyroid surgery is usually done for pregnant women or those who are not candidates for radioactive iodine.
  • Toxic solitary nodules:

- Surgery or radioactive iodine (see guidelines above)

    1. Propranolol
    2. Radioactive iodine is effective in large doses
    3. Surgery can be done, but usually only for those not qualifying for radioactive iodine.

- Propranolol and anti-inflammatories for symptoms. This condition usually resolves itself.

  • Graves' ophthalmopathy -- there is no treatment for mild cases.  Prednisone is given for more severe cases.  In cases that fail to respond, radiation treatment or surgical decompression may be considered.  Artificial tears are used if the patient's eyes are dry.  The eyelids are taped shut during sleep if lid lag keeps them open.
  • Atrial fibrillation is usually reversed for treatment with Hyperthyroidism.  Propranolol and Digoxin may be used.  If complications persist after treatment for Hyperthyroidism, electrical cardioversion or long term anti-coagulation may be needed.
  • Congestive Heart Failure -- same treatment as typical Congestive Heart Failure.
  • Thyroid storm --Propylthiouracil or Methimazole every six hours, followed by Lugol's solution one hour later.  Propranolol is given intravenously.  Corticosteroids (e.g., Solumedrol) are given every six hours.  Definitive surgical treatment is performed only after thyroid functions have stabilized.
  • Hyperthyroidism in pregnancy --Propylthiouracil at the lowest dose possible.  Surgery if Propylthiouracil is not sufficient.
  • Dermopathy (skin changes) -- topical corticosteroids with nocturnal plastic occlusive dressing.

  • Graves' ophthalmopathy -- lymphocytes (immune fighting cells in the blood) infiltrate the muscles of the eye, resulting in the enlargement of the eyeball, lid lag, severe dry eyes, and compression of the optic nerve.
  • Atrial fibrillation -- a heart irregularity that increases the risk of Stroke
  • Congestive Heart Failure
  • Thyroid storm -- an extremely severe form of Hyperthyroidism that can be life threatening. The patient usually experiences Delirium, Dehydration, rapid heart rate, vomiting, Diarrhea and a high fever.  This is a medical emergency and is life-threatening.  If suspected this condition, you need immediate emergency medical treatment.
  • Other complications include decreased libido, Impotence, decreased sperm count, enlarged male breasts, and a syndrome called periodic paralysis (sudden episodes of paralysis).

more about Thyrotoxicosis

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