Hyperthyroidism is a hypermetabolic state caused by increased thyroid secretion. There are several types, including Graves' disease (the most common cause), toxic nodular goitre, and toxic adenoma. Clinical features include symptoms like fatigue, heat intolerance, and weight loss, as well as signs like tachycardia, eye changes, and thyroid swelling. Diagnosis involves clinical evaluation, thyroid function tests, and scans. Treatment options are antithyroid drugs, surgery, and radioactive iodine.

1. Hyperthyroidism

2. Objectives
• To understand types ,clinical features ,
investigation and management of
hyperthyroidism

3. Overview
• Definition
• Types
• clinical features
• Investigation
• Treatment

4. Hyperthyroidism
Disease process associated with increased
thyroid secretion result in predictable hyper
metabolic state

5. • Types:
Primary thyrotoxicosis
1. Diffuse toxic goitres- graves disease
Secondary thyrotoxicosis
2. Toxic nodular goitre
3. Toxic nodule
4. Hyperthyroidism due to rare cause
Hyperthyroidism

6. Diffuse toxic goitre (graves)
• Most common cause of hyperthyroidism
• Irish physician-Dr Robert Graves in 1835
• Common-young females(20 to 40)
• Whole gland involved
• 50% family h/o autoimmune endocrine disease
• Hypertrophy and hyperplasia-abnormal TSH –R
Ab bind to TSH receptor disproportionate and
prolonged effect
• Genetic susceptibility

7. Toxic nodular goitre
• Middle aged/elderly
• Eye signs –rare
• Secondary TT
• Nodules-inactive
• Internodular tissue - overactive
• Toxic adenoma-autonomous

8. Toxic nodule
• Solitary overactive nodule
• Part of generalised nodularity or two toxic
adenoma
• Autonomous
• TSH- suppressed by high T3 and T4
• Normal surrounding thyroid tissue –
suppressed and inactive

9. Histology
• Normal acini- with flattened cuboidal
epithelium and filled with homogenous colloid
• Hyperthyroid – acini hyperplasia
- lined by high columnar epi
- empty or vacuolated colloid
- characteristic scalloped pattern
adjacent to thyrocytes

10. Clinical Features
• Symptoms
– Tiredness
– Emotional liability
– Heat intolerance
– Weight loss
– Excessive appetite
– Palpitation
– Diarrhoea
– Amenorrhoea
– Blurring of vision or double vision

11. • Signs
– Tachycardia
– Hot moist palms
– Exophthalmos
– Lid lag retraction
– Agitation
– Thyroid swelling
– bruit

12. • Cardiac rhythm
• - Increased sleeping heart rate( sinus tachycardia)
- Arryhthmias, multiple extra systoles, paroxysmal
atrial tachycardia
- Paroxysmal atrial fibrillation
- Persistent atrial fibrillation, no response to digoxin
• Myopathy
– Proximal limb muscle weakness ( thyrotoxic
myopathy)

13. Eye Signs
• Exophthalmos
– Unilateral or bilateral
– Infiltration of retrobulbar tissue with fluid and
round cells
• Retraction/spasm of upper eyelid
• Levator palpabre superiaris supplied partly by
sympathetic fibers
• Graves ophthalmopathy is autoimmune
disease

14. • Diplopia –weakness of elevator (inferior
oblique
• Papilloedema and corneal ulcer
• Malignant exophthalmos
• Graves ophthalmopathy-autoimmune disease-
Ab mediated effects on the ocular muscles

15. • Von Graefe's sign (lid lag sign)
• Dalrymple's sign
• Joffroy sign (absent creases in the forehead on
superior gaze)
• Möbius sign (poor convergence)
• Stellwag sign (incomplete and infrequent
blinking

18. • Pretibial myxoedema
thickening of skin –mucin like deposit

19. • Thyroid acropathy

20. • Thyrotoxicosis factitia:
thyroxine induced (0.2 -0.3 mg)
• Jod - basedow thyrotoxicosis
jod = iodine (german)
• Neonatal thyrotoxicosis : increased TSH Ab
subsides : 3-4 weeks

21. Diagnosis
1. Clinical
2. Thyroid profile
3. Thyroid scan-autonomous nodule
4. –children with growth spurt ,behaviour
problems or myopathy
- tachycardia /arryhthmia in elderly
- unexplained diarrhoea
- loss of weight

23. Treatment
1. Rest , Sedation
2. Antithyroid drugs
3. Surgery
4. Radioiodine

24. Drugs
1. Antithyriod drugs- <45yr small goitre
- carbimazole
- propylthiouracil
- oxidation and binding of Iodine to tyrosine
2. B Adrenergic blockers
-propranolol,nadolol
3. Iodides

25. • Advantages : no surgery
rapid control of thyrotoxicosis
• Disadvantages : treatment is prolonged
failure rate-50%
• SE : agranulocytosis / aplastic anemia
Dose :10mg 3-4 times/day
• Replacement – thyroxine 0.1 mg – 0.15 mg

26. Surgery
• <45 yr large goitre
• Toxic nodule
• Toxic nodular goitre
• Advantage: goitre removed
Cure rapid
Cure rate-high

27. • Disadvantage : recurrence - 5%
- risk of surgery
- hypothyroidism-20-45%
- hypoparathyroidism

28. Radio iodine
• Indictions : >45 yr
rec thyrotoxicosis after surgery
• Advantages : no surgery ,no drug
• Disadvantages : isotope facility must be
available

29. THANK YOU