Signs and Symptoms of Thyrotoxicosis

• Hyperthyroidism is approximately 10 times less common than hypothyroidism:
  • Symptoms and signs of thyrotoxicosis are listed in the Table.
• Hyperthyroid elderly patients often have more cardiac symptoms but less systemic manifestations of thyrotoxicosis.
• Patients with suspected hyperthyroid syndrome should be evaluated for signs or symptoms of:
  • Weight loss, heat intolerance, tremor, palpitations, anxiety, menstrual abnormalities, and new onset atrial fibrillation.
  • Evaluation should be considered, especially in patients with increased risk of hyperthyroidism, including:
    • A strong family history of thyroid dysfunction (hypothyroidism and hyperthyroidism)
    • Other autoimmune conditions
    • Long-standing goiter:
      • Especially after contrast or amiodarone administration.
• Routine screening of asymptomatic patients for hyperthyroidism is not recommended.

General	Skin
Weight loss	Excess perspiration
Heat intolerance	Palmer erythema
Anxiety / nervousness
Insomnia	Nervous System
Muscle weakness	Tremor
	Anxiety / nervousness
Cardiovascular	Hyperkinesis
Tachycardia
Palpitations	Gastrointestinal
Dyspnea on exertion	Frequent stools / diarrhea
Bounding pulses
Atrial fibrillation	Reproductive
	Irregular menstrual periods / amenorrhea
Head and Neck	Light menstrual flow
Ophthalmopathy (Graves’ disease only: proptosis and chemosis)	Infertility
Stare	Gynecomastia (males)
Goiter

 

• Thyroid Tests in the Evaluation of Thyrotoxicosis
  • Measurement of serum TSH:
    • Is the most sensitive way to diagnose hyperthyroidism:
      • As it is always suppressed in primary hyperthyroidism.
    • Patients with hyperthyroidism will almost always have a serum TSH concentration of:
      • Less than 0.1 mIU/L and often under 0.05 mIU/L:
        • The use of a second-generation TSH assay with a functional sensitivity of < 0.2 mIU/L is sufficient for the diagnosis and management of hyperthyroidism.
    • Secondary hyperthyroidism from a:
      • Is extremely rare but should be suspected when the patient has symptoms suggestive of hyperthyroidism with an inappropriately “normal” TSH:
        • This rare clinical condition should be referred to an endocrinologist for further diagnosis and management.
  • Certain medical conditions (severe non-thyroidal illness, acute starvation, first-trimester pregnancy) and medications (glucocorticoids, dopamine), in addition to hypothalamic or pituitary disease:
    • Can result in low TSH:
      • If any of these conditions are suspected:
        • The help of a specialist is invaluable for determining the thyroid status of the patient.
  • An algorithm for ambulatory thyroid function testing for hyperthyroidism is shown:

 

• If the TSH is within normal limits:
  • The patient does not have hyperthyroidism:
    • No further workup is indicated:
      • Thyroid function tests should be repeated as clinically indicated.
• If the TSH is less than 0.3:
  • Thyroid hormone levels should be determined in addition to repeat measurement of TSH:
    • Small increases of the thyroid hormone level will cause:
      • A disproportionate suppression of TSH because of their inverse log-linear relationship.
    • The degree of hyperthyroidism cannot be assessed by second-generation assay TSH:
      • Because even very mild thyrotoxicosis will suppress the TSH to very low levels.
    • Although a third-generation assay can better differentiate between the degrees of hyperthyroidism:
      • Routine laboratory measurements of:
        • Total T4, THBR, FT4I, and total T3 can easily and accurately assess the degree of hyperthyroidism.
        • Measurement of total T3 is needed in the evaluation of hyperthyroidism:
          • Graves’ disease excretes a relatively high ratio of T3 / T4.
        • If serum TSH is less than 0.3 and FT4I and total T3 is low:
          • Hypothalamic or pituitary disease needs to be considered.

Rodrigo Arrangoiz MS, MD, FACS a head and neck surgeon / endocrine surgeon / surgical oncologist and is a member of Sociedad Quirúrgica S.C at the America British Cowdray Medical Center in Mexico City:

• He is an expert in the surgical management of thyroid diseases.

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

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http://www.cirugiatiroides.com

http://www.sociedadquirurigca.com

http://www.hiperparatiroidismo.info