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Thyrotoxicosis
1.
2.
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
as thyroiditis.
7.
Long standing nodular goitre
Middle aged women
infrequently associated with eye signs
Internodular tissue is the active region
Rarely , autonomous nodules.
8.
Overactive nodule part of generalised
nodularity or true toxic adenoma.
Not related to TSH-R Abs.
Normal thyroid tissue is suppressed and
inactive.
16.
Rx
Control of hyperthyroidism
Sleeping propped up position
Lateral tarsoraphy
Prednisone
Intraorbital steroid are to be avoided.
Thryoid ablation with radio iodine worsens the
malignant exophthalmus
Orbital decompression.
21.
Anti thyroid durgs
Carbimazole and propylthiouracil,
Beta blockers – propranolol and nadolol
Iodides – reduce vascularity, preoperative
scenario
Cannot cure toxic nodule
22.
23.
Dosage – 10 mg of carbimazole tds can be
increased up to 120mg per day.
Levels of TSH R Ab fall and permanent cure in
50%
BLOCK AND REPLACEMENT REGIMEN
Inhibit all T3 and T4 with high dose of carbimazole
and replace with thyroxine 0.1-0.15mg
24.
Helps in reducing the mass of overactive
tissue.
Reduction of TSH R Abs or only limited
stimulation.
Toxic nodule – suppressed tissue acts normal
after the surgery.
25.
Destroys thyroid cells.
Functioning tissue reduced beyond critical
level.
Accurate dosage is difficult and may require
further dose after 12 weeks.
No evidence proven – therapeutic dosage is
carcinogenic.
26. Anti- thyroid
drugs
Surgery
Radioiodine
• No surgery and
radio iodine
effects
• Goitre is removed
• Cure is rapid
• High cure rate
• No prolonged
drug therapy
• prolonged
• 50% failure rate
• difficult to
predict response.
• agranulocytosis
or aplastic
anemia
• Permanent
thyroid failure
• Hypoparathyroidi
sm
• Recurrence <5%
• indefinite follow
up
• slow response
• Accurate dosage
- difficult
27.
Factors influencing
Type of thyrotoxicosis
Age of the patient
Co existing medical illness
Post treatment care
Follow up
Compliance and
Patient wishes.
31. Pregnancy
Radio iodine –
absolute C/I
Surgery – abortion
Drugs –
hypothyroidism both
mother abd baby
Surgery in
second trimester
or careful
administration of
drugs
Children
Radio iodine –
C/I
Surgery recurrence
Drugs till
adoloscents
Surgery later.
Thyrocardiac
Severe cardiac
damage
Radio iodine
with anti
thyroid drugs