HYPERTHYROIDISM

It When the production of thyroid hormones by the thyroid gland exceeds the normal levels
the condition is known Hyperthyroidism.

Etiology-
Following are the related cause of hyperthyroidism

1) Grave’s dieses:
 It is one of the primary cause for hyperthyroidism. It is an auto immune
disorder characterized by excessive production of thyroid hormones due to the
production of abnormal immunoglobulins.
 These immunoglobulins also called as thyroid receptor anti bodies(TRAbs)
occupy the TSH receptor in the thyroid gland and stimulate cell division and
increase production of T3 and T4.
2) Modular dieses:
 Toxic multinoclular and single thyroid adenomas result in hyperthyroidism due
to excessive secretion of thyroid hormones by the tumours. These are
generally found in elderly women.
3) Thyroiditis:
 Inflammation of thyroid gland due to immune attack on viral infection result in
the destruction of follicular cells of the thyroid gland hormones for a fraction
of time, Thus, thyrotoxicosis due to thyroiditis is brief and occur in patient on
antithyroid drug.
4) Drug induced thyrotoxicosis:
 Hyperthyroidism that results due to use of specific drug like aminodarane,
lithium, ioclicles, cytolcines, etc is referred as drug included thyrotoxicosis.

Epidemiology-
The prevalence of hyperthyroidism in women is between 0.5 and 2% and is ten times more
common in women than in men. Epidemiological studies suggest that 1% of men and 5% of
women have thyroid nodules detected clinically and that the frequency increases with age and
in iodine-deficient populations.

Sings and Symptoms-

 Losing weight without trying.
 Fast heartbeat, a condition called tachycardia.
 Irregular heartbeat, also called arrhythmia.
 Pounding of the heart, sometimes called heart palpitations.
 Increased hunger.
 Nervousness, anxiety and irritability.
 Tremor, usually a small trembling in the hands and fingers.
 Sweating.
 Changes in menstrual cycles.
  Increased sensitivity to heat.
 Changes in bowel patterns , especially more-frequent bowel movements.
 Enlarged thyroid gland, sometimes called a goiter, which may appear as a
swelling at the base of the neck.
 Tiredness.
 Muscle weakness.
 Warm, moist skin.
 Thinning skin.
 Fine, brittle hair.

Diagnosis-
1. Increased levels of free plasma thyroxine(Tu) triiodothyronine (T3) and decreased or
undetectable levels of TSH indicate the presence of hyperthyroidism.
2. Grave’s disease is diagnosed by increases levels of T3 and by the presence of thyroid
receptor antibodies (TRAbs).
3. Thyroid scan serves as ausebul diagnostic procedure. Patient suffering from
hyperthyroidism often have an enlarged, homogenous gland.
4. Presence of nodules can be confirmed by conducting radio active iodine update and
thyroid scan tests increases vsd levels of free T3 and presence of nodules are some of
its indications.
Low uptake of radioactive iodine, decreases rsd TSH levels, increases rsd levels of
thyroid hormones, leukocytosis increases ESR and absence of thyroid antibodies confirm
the presence of subacute thyroiditis.
The extra ocular muscles are swollen and become tethered leading to failure of movement
of the globe of the eye and thus diplopia.
The cutaneous feature of grave’s disease include thickening of the pretibial skin, only
enolysis and ucropueny.

PATHOPHYSIOLOGY

TREATMENT-
 1. Pharmacologic therapy:
Thioamides;
Egs:-
 Propylthiouracil
 Carbimazole
 Methimazole
Thioamides are used to control thyrotoxicosis disease as well as toxic nodular goitre.
 They are well tolerated by majority of patient, even by children and pregnant women.
 They do not cause any harm to parathyroid (or) laryngeal nerve.
Propylthiouracil
ID - 300 - 400 mg/ day
MD – 50 – 150mg
Methimazole:
ID – 30 – 40 mg OD
MD – 3 – 15 mg OD
Ranes
Fever agranulocytosis
Nausea
Bone marrow suppression

Iodides:
Eg’s:-
Ag.KI solution lugois iodine.
Given 10-14 days prior to surgical removal of thyroid gland
Dose:- 5 – 10 drops of 50mg/drop KI, tid by oral route.
In thyroid storm.

Mechanism of action:-
Iodides act by inhibiting hormone release and by decreasing the vascularity of thyroid gland
ADR:- Hypersensitivity reactions including coryza like
Symptoms
 Rashes, lacrimation, metallic taste.
Iodinated contract media.
Eg’s:- Ipodate, iopanoic acid, sodium thypropanoate
Carbimuzole:-
40-60mg OD thyroid function should be reevaluated every 2-4 months

Mechanism of action:-
Inhibits the production of thyroid peroxides responsible for intra thyroidal oxidation of
iodines.
 Prevents peripheral conversion of T4 to T4. It also occurs exerts immune suppressive
effects and therefore inhibits TRAbs.

ADR:-
 GI disturbance
 Skin rusnes
 Joint pains

Ionic inhibitors
Egs :- Perchlorates
Thiocyanates
Nitrates
Used with anti thyroid drug for amino clarone included hyperthyroidism
DOSE:- lg/day for 2-6 weeks

Mechanism of action:-
 It acts by inhibiting iodine binding thioamides; used in storm, i.e thyrotoxics is
Iopunoic 3gm every 3rd day
 Date:- 0.5-lg/day, or aky.

Radioactive Iodine therapy

This is preferred choice of treatment cardiovascular complication and in people who are
suffering from toxic multinodular goitres.

NON- PHARMACOLOGICAL
 High calorie diet in order to replace all the energy burned by the body in hyperthyroid
state.
 Drink plenty of water and juices to replace all the fluid losses. Avoid or limit
caffeinated drinks for such could produce anxiety.