This disease result from an excess of
circulating thyroid hormone.
Its very important to distinguish disorders:
1.Cause excess production of hormone - characterized by
increasing in radioactive iodine uptake.
2.An other condition which release stored hormone such
Not all manifestations are related to elevated
THYROXINE IS THE
ADRENALINE TO ACT
ON THE CELL
Firm , diffuse and
vascular / Bruit
Lid lag and spasm
Lid spasm – sympathetic overactivity
Joffrey’s and VonGraffe’s sign
Auto immune etiology – glycosamino glycans
Weakness of extraoccular muscle
Pappilloedema and corneal ulcers
exophthtalmus – eyes
may be destroyed.
Control of hyperthyroidism
Sleeping propped up position
Intraorbital steroid are to be avoided.
Thryoid ablation with radio iodine worsens the
Anti thyroid durgs
Carbimazole and propylthiouracil,
Beta blockers – propranolol and nadolol
Iodides – reduce vascularity, preoperative
Cannot cure toxic nodule
Dosage – 10 mg of carbimazole tds can be
increased up to 120mg per day.
Levels of TSH R Ab fall and permanent cure in
BLOCK AND REPLACEMENT REGIMEN
Inhibit all T3 and T4 with high dose of carbimazole
and replace with thyroxine 0.1-0.15mg
Helps in reducing the mass of overactive
Reduction of TSH R Abs or only limited
Toxic nodule – suppressed tissue acts normal
after the surgery.
Destroys thyroid cells.
Functioning tissue reduced beyond critical
Accurate dosage is difficult and may require
further dose after 12 weeks.
No evidence proven – therapeutic dosage is
• No surgery and
• Goitre is removed
• Cure is rapid
• High cure rate
• No prolonged
• 50% failure rate
• difficult to
• Recurrence <5%
• indefinite follow
• slow response
• Accurate dosage
Type of thyrotoxicosis
Age of the patient
Co existing medical illness
Post treatment care
Large goitre –
Small goitre –
drugs or radio
Enlarges with antithyroid drugs.
Responds poorly with drugs and radio iodine
Surgical removal is the treatment.
Surgery vs Radio Iodine.
Pros and cons to be considered.
Radio iodine –
Surgery – abortion
mother abd baby
Radio iodine –
Large doses of iodine in endemic goitre