Hyperthyroidism

Published on 10/03/2015 by admin

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Last modified 10/03/2015

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Chapter 20 HYPERTHYROIDISM

Theodore O’Connell

Hyperthyroidism is a hypermetabolic state that results from excess synthesis and release of thyroid hormone, usually from the thyroid gland. The overall incidence of subclinical and overt hyperthyroidism is estimated to be 0.05% to 0.1% in the general population. Hyperthyroidism occurs in all age groups and is more common in women than in men. Graves’ disease is the most common cause of hyperthyroidism, causing 60% to 80% of cases. However, toxic nodular goiter is the most common cause of hyperthyroidism in the elderly.

Hyperthyroidism may manifest as a condition in a spectrum ranging from asymptomatic, subclinical hyperthyroidism to life-threatening thyroid storm. Subclinical hyperthyroidism is diagnosed in asymptomatic patients with low levels of thyroid-stimulating hormone (TSH) but normal free thyroxine (T4) and free triiodothyronine (T3). Clinical hyperthyroidism manifests with the typical signs and symptoms outlined later in this chapter.

In elderly patients, the condition often represents a diagnostic challenge because they may have lone symptoms or atypical manifestations. They may have negative symptoms such as depression, lethargy, or apathetic facies. Elderly patients also may have only a small goiter, weight loss, worsening of underlying cardiovascular disease, or new-onset atrial fibrillation.

Medications Linked to Hyperthyroidism

Alemtuzumab (Campath 1-H) (a monoclonal antibody)

Highly active antiretroviral therapy (HAART)

Key Historical Features

✓ Constitutional symptoms

• Excessive perspiration

• Heat intolerance

• Nervousness

• Weight loss

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