Hyperthyroidism

#med #disease #y2023

Presentation :

Serum TSH and free T4
- If TSH is suppressed but T4 is normal, order free T3 to diagnose T3 toxicosis (rare)
Intake of exogenous thyroid hormone suppresses thyroglobulin levels, which makes its measurement useful (when low) in patients with thyrotoxicosis caused by surreptitious use of thyroid hormone
Antibodies need not be checked routinely in the evaluation of hyperthyroidism unless the diagnosis is unclear
- TSH-receptor antibodies and thyroid-stimulating immunoglobulins are associated with Graves disease
- An elevated serum ESR supports thyroiditis

Propranolol to rapidly reduce adrenergic symptoms
- Propranolol in particular among BBs inhibits the peripheral conversion of T4 to the more biologically active hormone, T3 via inhibition of 5'-monodeiodinase
- In pregnancy, PTU is used for 1st trimester, Methimazole in 2nd + 3rd
  Radioactive iodine is used for toxic multinodular goiter, toxic adenoma, and Graves disease (usually following failed drug therapy)
- Contraindicated in pregnancy or breastfeeding
- May aggravate Graves ophthalmopathy unless pretreated with glucocorticoids
Thyroidectomy is preferred as definitive therapy for hyperthyroidism in large goiter with compressive symptoms, or in pts
intolerant of other therapies
Treatment of subclinical hyperthyroidism is recommended for patients with thyroid-stimulating hormone level less than 0.1 μU/mL (0.1 mU/L) and cardiac risk factors, heart disease, high risk for osteoporosis, or symptoms.