Hyperthyroidism - HYPERTHYROIDISM Prevalence Women 2% Men...

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    HYPERTHYROIDISM   Prevalence Women    2% Men    0.2% 15% of cases occur in  patients     older than 60 years of age
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      Clinical Symptoms Depends on Age of patient Magnitude of hormonal excess Presence of co-morbid condition
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Mechanism of Clinical Symptoms 1.  Catabolism 2.  Enhancement of sensitivity to                                  catecholamines
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        Clinical Symptoms Clinical manifestations of hyperthyroidism  are largely independent of its cause. However, causing disorder may have  other effects. 
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Clinical Symptoms Older patient presents with lack of clinical signs and  symptoms, which makes diagnosis more difficult Thyroid storm  is a rare presentation, occurs after  stressful illness in under treated or untreated patient.    Characteristics          -Delirium                          -Dehydration         -Severe tachycardia           -Vomiting         -Fever         -Diarrhea
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Clinical symptoms Skin             -Warm           -May be erythematous (due to                       increased blood flow)                                 -Smooth- due to decrease in keratin -Sweaty and heat intolerance -Onycholysis –softening of nails and  loosening  of nail beds
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Clinical symptoms Hyperpigmentation   -Due the patient increase ACTH secretion  Pruritis  -mainly in graves disease Thinning of hair Vitilago and alopecia areata -mainly due to autoimmune disease Infilterative dermopathy -Graves disease, most common on shins
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          Clinical symptoms Eyes   Stare   Lid lag  *Due to sympathetic over activity  *Only Grave’s disease has ophthalmopathy -Inflammation of extraocular muscles, orbital fat and  connective tissue.    -This results in exopthalmos     -More common in smokers
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   Clinical symptoms Eyes Impaired eye muscle function (Diplopia) Periorbital and conjunctival edema Gritty feeling or pain in the eyes Corneal ulceration due to lid lag and proptosis Optic neuritis and even blindness
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 Clinical symptoms Cardiovascular System Increased cardiac output (due to increased oxygen  demand and increased cardiac contractibility.  Tachycardia Widened pulse pressure High output – heart failure
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 Clinical symptoms Cardiovascular System Atrial fibrillation, 10-20% of patients.  More common  in elderly Atrial ectopy 60% of A-fib will convert to normal sinus rhythm with  treatment (4-months of becoming euthyroid) Mitral valve problems LVH and cardiomyopathy 
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Serum Lipids Low total cholesterol  Low HDL Low total cholesterol/HDL ratio
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Hyperthyroidism - HYPERTHYROIDISM Prevalence Women 2% Men...

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