Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

Hyperthyroidism 771

■Medications: levothyroxine, triiodothyronine, amiodarone, contrast

dye

■Current or recent pregnancy

Signs & Symptoms

■Weight loss, fatigue, heat intolerance

■Anxiety, insomnia, nervousness

■Palpitations, dyspnea at rest or on exertion

■Diarrhea, loose stools, hyperdefecation

■Proptosis, diplopia, eye inflammation, decreased visual acuity

■Neck pain, neck swelling

■Anxiousness, weakness, insomnia

■Tachycardia: regular or irregular, bounding pulses

■Stare, lid lag, exophthalmos, chemosis

■Goiter: diffuse, nodular, tenderness

■Hands: tremor, warm, sweaty, erythema, onycholysis

■Skin: warm, sweaty, smooth, pretibial dermopathy

■BP: increased systolic or pulse pressure

■Hyperreflexia, restlessness

tests

■Basic Blood Tests

➣Free T4, TSH

■Specific Diagnostic Tests

➣Total T3, free T3, thyroid antibodies

■Imaging

➣Radioiodine-123 uptake and scan

differential diagnosis

■I-123 uptake increased:

➣Scan diffuse: Graves disease (GD), inappropriate TSH secretion,

molar pregnancy

➣Scan patchy: multinodular toxic goiter (MNTG), toxic adenoma

(TA)

■I-123 uptake decreased:

➣Subacute thyroiditis: viral (DeQuervain’s), lymphocytic (silent,

postpartum)

➣Levothyroxine excess:

Exogenous: iatrogenic, inadvertent, surreptitious

Endogenous: struma ovariae

➣Iodine excess: amiodarone, contrast, miscellaneous

■Other: bulky or metastatic well-differentiated thyroid cancer