Types of presentation Goitre Occurs in almost all presentations of Grave’s disease – in which case it is usually diffuse and symmetrical The eye signs – Ophthalmopathy Occurs in 50% of cases of Grave’s disease This is the typical presentation of Grave [almostadoctor.co.uk]

Case presentation A 59-year-old Caucasian man was admitted with lethargy and progressive weight loss for 6 to 8 months prior to presentation. [jmedicalcasereports.biomedcentral.com]

(apathetic hyperthyroidism) 100 results Apathetic thyrotoxicosis presenting with diabetes mellitus. [unboundmedicine.com]

Jaundice may be present, but is unusual. [ahcmedia.com]

`0 Precipitating event Absent 0 Present 10 Interpretation: Likelihood of Thyroid Storm Score: < 25 – Unlikely 25-44 – Impending >45 – Highly likely The patient’s presentation may reflect complications of thyroid storm (stroke, myocardial infarction, [cdemcurriculum.com]

• Weight Loss

  Lack of weight gain that is normal during pregnancy, or significant weight loss, despite having normal appetite. [hyperthyroidismsymptomsx.com]

  Case presentation A 59-year-old Caucasian man was admitted with lethargy and progressive weight loss for 6 to 8 months prior to presentation. [jmedicalcasereports.biomedcentral.com]

  Signs and SymptomsSigns and Symptoms – Tremulousness or jitteriness – Exophthalmos – Weight loss despite excellent appetite – hypermetabolic state – Insomnia – Fatigue – Palpitations – Heat intolerance – Sweating – Diarrhea – Deterioration in handwriting [slideshare.net]

  Hyperthyroidism can accelerate your body's metabolism, causing unintentional weight loss and a rapid or irregular heartbeat. Several treatments are available for hyperthyroidism. [mayoclinic.org]

  These apathetic patients were significantly older and had a longer duration of symptoms and greater weight loss. The study group had a rather typical apathetic, placid, or depressed appearance often thought to represent "old age depression." [annals.org]

• Congestive Heart Failure

  Cardiovascular symptoms, atrial fibrillation, and congestive heart failure were common. They typically had evidence of a moderately severe proximal myopathy. Thyromegaly, although usually present, was not prominent and was usually multinodular. [annals.org]

  Congestive heart failure should be treated with digitalis and diuretics even though congestive failure due to hyperthyroidism may be refractory to digitalis. Cardiac arrhythmias are treated with the usual antiarrhythmic agents. [emjournal.net]

  heart failure.  Cardiac hypertrophy has been reported in thyrotoxicosis of different etiologies.  Severe acropachy can be disabling and can lead to total loss of hand function - clubbing of fingers with osteoarthropathy, including periosteal new bone [slideshare.net]

  Sinus tachycardia, heart rate 100-140 2. Heart rate faster than 140 beats/min, hypotension, atrial dysrhythmias, congestive heart failure 3. Diarrhea, increased appetite with loss of weight 3. [emedicine.medscape.com]

  These include a rapid heart rate, a heart rhythm disorder called atrial fibrillation that increases your risk of stroke, and congestive heart failure — a condition in which your heart can't circulate enough blood to meet your body's needs. [mayoclinic.org]

• Fatigue

  Other symptoms of thyroid storm include chest pain,palpitations, shortness of breath,delirium,confusion, psychosis, stupor, and fatigue. Fatal health complications include heart attack and stroke. [hyperthyroidismsymptomsx.com]

  Fatigue B. Palpitations C. Weight Loss D. Heat intolerance E. All the above 42 2. The most common etiology of hyperthyroidism is A. Toxic Multinodular B. Graves C. Toxic Nodular D. Amiodarone induces 43 3. [slideplayer.com]

  Presentation Symptoms/Physical exam Hypothyroidism Hyperthyroidism Cold intolerance (↓ heat production) Heat intolerance (↑ heat production) Weight gain, ↓ appetite Weight loss, ↑ appetite Hypoactivity, lethargy, fatigue, weakness Hyperactivity Constipation [medbullets.com]

  In fact, I am normally fatigued, low mood etc. This matches the AT descriptions I have been reading. I don't remember any doctors mentioning this. I am wondering whether I should be having any different treatment, or test to confirm this. [healthunlocked.com]

  They may include Being nervous or irritable Mood swings Fatigue or muscle weakness Heat intolerance Trouble sleeping Hand tremors Rapid and irregular heartbeat Frequent bowel movements or diarrhea Weight loss Goiter, which is an enlarged thyroid that [icdlist.com]

• Acutely Ill Patient

  In acutely ill patients, euthyroid sick syndrome may manifest as a low to low normal TSH, low T3, and a normal T4 level. Medications associated with low TSH levels include glucocorticoids, octreotide, dopamine, dobutamine, and amiodarone. [thebigl.co]

• Steatorrhea

  General features of thyrotoxicosis Hyperactivity, irritability, altered mood Heat intolerance, sweating Palpitations Fatigue, weakness Weight loss with increased appetite Diarrhoea, steatorrhea Polyuria Loss of libido Oligomenorrhoea (infrequent periods [almostadoctor.co.uk]

  Gastrointestinal transit time is decreased, leading to increased stool frequency, often with diarrhea and occasionally mild steatorrhea. [webedcafe.com]

• Tachycardia

  Circulation: Tachycardia is common, either sinus tachycardia (most common rhythm) or atrial fibrillation (most common dysrhythmia). Supraventricular and ventricular dysrhythmias, including ventricular fibrillation, may occur. [cdemcurriculum.com]

  Cardiac symptoms may include congestive heart failure, which is often refractory to therapy, tachycardia, and a widened pulse pressure. [thebigl.co]

  A life-threatening thyrotoxic crisis (ie, thyroid storm) can occur: fever, tachycardia, neurologic abnormalities, and hypertension, followed by hypotension and shock. [slideshare.net]

  The most common cardiac manifestations of thyrotoxicosis are resting sinus tachycardia, supraventricular tachycardia including atrial fibrillation and atrial flutter with or without cardiac failure. [jmedicalcasereports.biomedcentral.com]

  Tachycardia, fever, hyperkinesis, tremor, proximal myopathy, periodic paralysis, bulbar palsy and hypercalcaemia respond. [aic.cuhk.edu.hk]

• Cardiomegaly

  His chest X-ray showed cardiomegaly but no pulmonary oedema. However his 12-lead electrocardiogram showed complete heart block with underlying atrial fibrillation (Figure 1 ). [jmedicalcasereports.biomedcentral.com]

  Most patients will have weight loss, evidence of cardiomyopathy, myopathy and may have atrial fibrillation, congestive heart failure, cardiomegaly and muscle weakness. Thyroid storm. [ocw.tufts.edu]

  The chest radiographic finding noted in some of these patients was essentially that of increased cardiothoracic ratio suggestive of cardiomegaly. [pjms.com.pk]

  - Echocardiography, which may disclose a pericardial effusion associated to cardiomegaly, increased thickness of all cardiac walls and reduced cardiac output. - Computed tomography (CT) of the brain that is normal in most patients with primary hypothyroidism [frontiersin.org]

• Excessive Tearing

  Signs and symptoms of Graves' ophthalmopathy include: Dry eyes Red or swollen eyes Excessive tearing or discomfort in one or both eyes Light sensitivity, blurry or double vision, inflammation, or reduced eye movement Protruding eyeballs When to see a [mayoclinic.org]

  The earliest manifestations of GO are a sensation of grittiness, eye discomfort, and excess tearing. [webedcafe.com]

  Table 1 Clinical features of thyroid-associated ophthalmopathy Signs and symptoms Assessment Approximate frequency a (%) Lid lag, lid retraction Measure lid fissure width 50–60 Grittiness, discomfort, excessive tearing, retrobulbar pain, periorbital oedema [enetmd.com]

• Lacrimation

  It is characterized by orbital pain, lacrimation, irritation, photophobia, increased retro-orbital tissue, exophthalmos, and lymphocytic infiltration of the extraocular muscles, causing ocular muscle weakness that frequently leads to double vision. [merckmanuals.com]

• Withdrawn

  Usually, these subjects have previously been taking l -thyroxine substitution therapy, unless they have subsequently withdrawn it on their own initiative. [frontiersin.org]

  Although β-blockers will rapidly alleviate symptoms in all types of hyperthyroidism, definitive treatment is also necessary, and when euthyroidism is restored β-blockers can be gradually withdrawn. [enetmd.com]

  The patient is mentally slow and withdrawn. The skin is dry, coarse, cool, and wrinkled. There may be muscle wasting and proximal myopathy. 53 Weakness in respiratory and skeletal muscles may be factors in decreased exercise tolerance and dyspnea. [ahcmedia.com]

• Fear

  However, it has been demonstrated that it is safe to administer I-131 to patients who are severely hyperthyroid without fear of TS, provided beta blockade drugs are used to control the signs and symptoms ( 67 ). [frontiersin.org]

  Excessive worrying O verall feeling of insecurity and instability Panic attacks Agoraphobia, a condition that renders its victims fearful of leaving their homes. [drllynch.com]

• Psychomotor Retardation

  Dementia and severe psychomotor retardation may be the most prominent findings. 60 The Heart in Thyrotoxicosis. Thyrotoxicosis increases the work of the heart. [ahcmedia.com]

• Polyuria

  General features of thyrotoxicosis Hyperactivity, irritability, altered mood Heat intolerance, sweating Palpitations Fatigue, weakness Weight loss with increased appetite Diarrhoea, steatorrhea Polyuria Loss of libido Oligomenorrhoea (infrequent periods [almostadoctor.co.uk]

  […] gonadotropin-secreting tumors Gestational thyrotoxicosis Table 2: Signs and Symptoms of Thyrotoxicosis Symptoms Hyperactivity, irritability Heat intolerance and sweating Palpitations Dysphoria Fatigue and weakness Weight loss with increased appetite Diarrhea Polyuria [webedcafe.com]

  Bullet list 3 Clinical features of thyrotoxicosis of any cause Symptoms Hyperactivity, irritability, altered mood Heat intolerance, sweating Palpitations Fatigue, weakness Weight loss with increased appetite Diarrhoea, steatorrhoea Polyuria Oligomenorrhoea [enetmd.com]

• Confusion

  Other symptoms of thyroid storm include chest pain,palpitations, shortness of breath,delirium,confusion, psychosis, stupor, and fatigue. Fatal health complications include heart attack and stroke. [hyperthyroidismsymptomsx.com]

  On examination, the patient appeared ill, prostrated, and confused. Blood pressure was 190/120 mm Hg, pulse was 148/min and irregular, and respiratory rate was 20/min. Mucous membranes were dry and a pulse deficit of 20 was present. [thefreelibrary.com]

  Confusion, agitation, delirium, frank psychosis, seizures, stupor or coma Certain unusual presentations include chest pain, acute abdomen, status epilepticus, stroke, acute renal failure due to rhabdomyolysis, and apathetic thyroidism. [emedicine.medscape.com]

  Skin usually moist and warm - confusion, fits, coma, muscle weakness. Very common. Features of UMN lesions have been described as has rhabdomyolysis and sudden onset of thyrotoxic periodic paralysis - arrhythmias, cardiac failure. [aic.cuhk.edu.hk]

  About 1 percent of patients with Graves’ disease develop myasthenia gravis, producing an occasional confusing clinical situation. [emjournal.net]

• Apathy

  The patient had a recent history of decreased mentation and apathy, and laboratory findings were found to be consistent with hyperthyroidism. [thefreelibrary.com]

  Apathy, or symptoms of depression? Often seen in elderly – apathetic hyperthyroidism. Are there associated cardiovascular complaints? Dyspnea? Chest pain? Acute myocardial infarction can trigger or be triggered by thyroid storm. [cdemcurriculum.com]

  Overt thyrotoxic crisis : Fever; extreme agitation and worsening of psychotic symptoms; sometimes somnolence, apathy, or even coma; in some cases, status epilepticus; sudden worsening of cardiovascular symptoms (severe tachycardia, atrial fibrillation [empendium.com]

  Apathy, stupor and coma may occur. Laboratory evaluation of thyrotoxicosis begins with a measurement of TSH. If TSH is suppressed ( Figure 1. [ocw.tufts.edu]

• Agitated Delirium

  Confusion, agitation, delirium, frank psychosis, seizures, stupor or coma Certain unusual presentations include chest pain, acute abdomen, status epilepticus, stroke, acute renal failure due to rhabdomyolysis, and apathetic thyroidism. [emedicine.medscape.com]

  […] or delirium to extreme lethargy or coma, and, rarely, seizures. [clinicaladvisor.com]

HYPERTHYROIDISM (THYROTOXICOSIS) Workup This disorder is the result of an excessive concentration of circulating thyroid hormone. [thebigl.co]

Truly refractory disease is rarely found in a properly conducted workup. Postgraduate Medicine 2000;107:123-45. 33. Klein I, Ojomata K. Thyroid hormone and blood pressure regulation. [pjms.com.pk]

[…] with thyrotoxicosis demonstrate no clinical signs or symptoms of a goiter and may even have depressive signs, such as apathy and fatigue. 7 This genre of clinical symptoms is termed “apathetic hyperthyroidism” and is often diagnosed after a lengthy workup [aneskey.com]

PubMed PMID: 11589682. 2) Serum antibodies to thyroperoxidase ( TPO )—TPO Ab—and antibodies to thyroglobulin ( Tg )—Tg Ab—(least specific): Measurement of TPO Ab and Tg Ab is not suggested for the workup of patients with low TSH values, Weak recommendation [empendium.com]

The American College of Emergency Physicians lists thyroid screening tests in its guidelines for the workup of the elderly patient with lethargy, agitation, or any alteration in level of consciousness. 20 Weight loss results in depletion of fat stores [ahcmedia.com]

Significant updates on bariatric surgery, Barrett's esophagus, endoscopic ultrasound, endosonography, treatment of liver disease, and much more keep you current on the latest advances. [books.google.com]

Patients must be monitored for side effects of anti-thyroid drug treatment (see above); any major adverse effects require discontinuation of anti-thyroid drug treatment and selection of another treatment option. [clinicaladvisor.com]

Up to 30% of women can cease treatment by the third trimester. The baby should be checked straight after birth, as treatment in this way can cause a goitre. [almostadoctor.co.uk]

Surgical Treatment (Thyroidectomy) 1. [empendium.com]

Decreasing pulse rate and BP with the development of shock are associated with poor prognosis - vomiting, diarrhoea. [aic.cuhk.edu.hk]

Presence of jaundice suggests especially poor prognosis. Ultimately, thyroid storm is a clinical diagnosis and requires prompt recognition and treatment. [mdcalc.com]

(Textbook chapter presenting clinical manifestations, treatment options, and prognosis of hyperthyroidism in children.) Bahn Chair, RS, Burch, HB, Cooper, DS. [clinicaladvisor.com]

The nature and prognosis of heart disease in thyrotoxicosis. Q J Med 1959;28:347-70. 30. Yang YS, Chang CC, Su DH. Unusual presentation of thyrotoxicosis as bradycardia, acute renal failure and hyperuricaemia in an elderly patient. [pjms.com.pk]

The disease mainly affects female gender and the prognosis is usually favorable, except for malignancies ( 106, 107 ). [frontiersin.org]

[…] most common) Idiopathic causes Ablative therapy Iodine deficiency May be transient Pathophysiology is unclear but may be viral in nature 23 Hypothyroidism Etiologies of Hypothyroidism Primary Autoimmune etiologies Hashimotos is the most common Idopathic [slideplayer.com]

 Cardiac hypertrophy has been reported in thyrotoxicosis of different etiologies.  Severe acropachy can be disabling and can lead to total loss of hand function - clubbing of fingers with osteoarthropathy, including periosteal new bone formation, [slideshare.net]

However, these patients are often critically ill and the complications or inciting etiology of the patient’s thyroid storm may require active airway intervention. [cdemcurriculum.com]

Therapy for hyperthyroidism depends on the etiology. [thebigl.co]

Ongoing controversies regarding etiology, diagnosis, treatment Thyroid storm is a rare complication of thyrotoxicosis. [clinicaladvisor.com]

Epidemiology/Pathophysiology Graves' disease is the most common form of hyperthyroidism accounting for 60-70% of all cases. It occurs in up to 3% of the population. [ocw.tufts.edu]

These antibodies stimulate the thyroid gland to produce more T3 and T4 Epidemiology Can occur at any age Peak onset age 40-60 F:M 5-10 : 1 Aetiology Environment triggers include: High iodine intake Stress Smoking Smoking is also a major risk factor in [almostadoctor.co.uk]

Amer J Epidemiology 2003;157:1101-7. 17. Rojeski MT, Gharib H. Nodular thyroid disease. New Eng J Medicine 1985;4:249-53. 18. Czarkowski M, Hilgertner L, Powalowski T, Radomski D, Mikulska M. [pjms.com.pk]

Epidemiology The prevalence of thyrotoxicosis in white people is 2 to 3% in women and 0.2 to 0.3% in men. The peak age of onset for Graves’ disease is between 20 and 50 years of age, whereas toxic multinodular goitre occurs more often in later life. [enetmd.com]

Epidemiology Graves’ disease occurs in approximately 1:5,000 children. There is no seasonal variation. The peak age of Graves’ disease is in adolescence; it is more common in females (~5:1 female:male ratio). [clinicaladvisor.com]

12 - 912 ページ Werner & Ingbar’s The Thyroid: A Fundamental and Clinical Text, 10th Edition has been extensively revised and streamlined to deliver the most comprehensive coverage of the thyroid including anatomy, development, biochemistry, physiology, pathophysiology [books.google.com]

Epidemiology/Pathophysiology Graves' disease is the most common form of hyperthyroidism accounting for 60-70% of all cases. It occurs in up to 3% of the population. [ocw.tufts.edu]

[…] secretion Occurs more frequently in women (0.6 to 5.9 %) The most common etiologies are Primary thyroid failure due to autoimmune diseases (Hashimoto thyroiditis is the most common) Idiopathic causes Ablative therapy Iodine deficiency May be transient Pathophysiology [slideplayer.com]

PATHOPHYSIOLOGY The exact pathogenesis of thyroid storm has not been defined. It is attractive to attribute storm to excess thyroid hormone production or secretion. [emjournal.net]

In Laragh JH, Brenner BM, editors, Hypertension, pathophysiology, diagnosis and management. 2nd Edition, New York Raven Press 1995;2247-62. Professional Medical Publications Room No. 522, 5th Floor, Panorama Centre Building No. 2, P.O. [pjms.com.pk]

Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets [books.google.com]

In brief: The management strategy for thyroid storm revolves around preventing peripheral effects of raised thyroid hormone levels, and preventing the ongoing increase of said levels by inhibiting the synthesis and release of thyroid hormone. [derangedphysiology.com]

Chlorpromazine 25-50 mg 4-6 hrly to prevent shivering - fluid replacement. [aic.cuhk.edu.hk]

[…] relases of hormone (after synthesis blockade intiated) Iodine Iaponoric acid (Telepaque) 1 gm IV q8h for the first 24 h, then 500 mg bid or Potassium iodide (SSKI) 5 drops PO q6h or Lugol solution 8-10 drops PO q6h Lithuim mg PO every day Prevent peripheral [slideplayer.com]