This document provides information on hyperthyroidism in children, including definitions, epidemiology, causes, clinical features, diagnosis, and management. The most common causes of hyperthyroidism in children are Graves' disease, toxic multinodular goiter, and subacute thyroiditis. Symptoms can include excessive sweating, heat intolerance, rapid heart rate, tremors, and weight loss. Diagnosis involves testing thyroid hormone levels, TSH, and thyroid antibodies. Treatment options include beta-blockers for symptom relief, antithyroid medications, radioactive iodine, and surgery. The goals of treatment are to normalize thyroid hormone levels and resolve symptoms of hyperthyroidism.
This presentation was done by Dr. Julius P. Kessy,MD. An intern Doctor at Dodoma Regional Referral Hospital (DRRH) during pediatrics unit clinical meeting and supervised by Dr. Christina K. Galabawa,MD,Mmed2, Pediatrics and Child Health, University of Dodoma (UDOM) in November, 2017.
in this presentation lecture we gone take a hypo and hyper thyrodism that affect the human cell because both situation may increase or decrease the basal metabolic rate.
This presentation was done by Dr. Julius P. Kessy,MD. An intern Doctor at Dodoma Regional Referral Hospital (DRRH) during pediatrics unit clinical meeting and supervised by Dr. Christina K. Galabawa,MD,Mmed2, Pediatrics and Child Health, University of Dodoma (UDOM) in November, 2017.
in this presentation lecture we gone take a hypo and hyper thyrodism that affect the human cell because both situation may increase or decrease the basal metabolic rate.
2012 Clinical Practice guidelines for hypothyroidism in adults: American Asso...Jibran Mohsin
This is presentation format of 2012 Clinical Practice guidelines for hypothyroidism in adults: American Association of Clinical Endocrinologists (AACE) / American Thyroid Association (ATA)
In this presentation I have covered benign thyroid pathology, mainly hypothyroidism and hyperthyroidism with its sub-type, clinical presentation and lab investigations. Hope it helps to understand the pathology better.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
2. Concept map
■ What are hyperthyroidism & thyrotoxicosis
■ Epidemiology
■ Causes
■ Clinical features
■ Diagnosis
■ Management
3. Definitions
■ Thyrotoxicosis - clinical state that results from
inappropriately high thyroid hormone action in
tissues generally due to inappropriately high
tissue thyroid hormone levels
■ Hyperthyroidism – a form of thyrotoxicosis due
to inappropriately high synthesis and secretion
of thyroid hormone(s) by the thyroid
• Bahn et al. Hyperthyroidism andOtherCauses ofThyrotoxicosis: ManagementGuidelines of the AmericanThyroid Association and American
Association of Clinical Endocrinologists.Thyroid, 2011Jun;21(6):593-646 & Endocr Pract, 2011 May-Jun;17(3):456-520
4. Epidemiology
■ Estimated prevalence of hyperthyroidism in children is around 1 in 10,000 in
the United States’ pediatric population.
■ Prevalence : 1.2 % (0.5% - overt, 0.75% subclinical)
■ Hyperthyroidism is much more common in women and in older people.
■ 5 % of all cases of Graves’ disease occurs in children.
■ Age
– Graves disease 20 to 40
– Toxic MNG > 50 yrs
– Toxic Single Adenoma 35 to 50
– Sub AcuteThyroiditis Any age
■ Sex M : F ratio
– Graves Disease 1: 5 to 1:1
– Toxic MNG 1: 2 to 1: 4
5. Possible Etiology of Hyperthyroidism
■ Primary
– Graves’ Disease (DiffuseToxic Goiter)
■ Secondary
– Toxic NodularGoiter (Multinodular Goiter)
– Thyroiditis
– Functioning adenoma of thyroid
– Rare Causes
■ Excessive intake of thyroid hormones
■ Abnormal secretion ofTSH
■ Excessive intake of iodine
■ Pituitary tumors leading to excessTSH
■ Thyrotoxicosis factitial: INF, amiodarone, SSRI
■ Struma ovarii (dermoid and ovarian tumors)
6. Graves’ Disease
■ Most common cause of thyrotoxicosis (50-60%)
■ Organ specific autoimmune disease
■ Most imp autoantibody:
– Thyroid stimulating immunoglobulin (TSI orTSA) which acts as a proxy for
TSH and stimulatesT4 andT3 via the adenyl cyclase cAMP system
I123 or TC99m Normal v/s Graves
• Onset may be insidious
• Poor school performance may be
marked, but usually from poor
concentration, tiredness and
behavior disturbances with temper
tantrums and emotional lability
7. Toxic Multinodular Goiter (TMG)
■ 2nd most common cause of hyperthyroidism (20%)
■ More in elderly individuals
■ Lumpy bumpy thyroid
■ Milder manifestations (apathetic hyperthyroidism)
■ Mild elevation of FT4 and FT3
■ Slow progression
■ Multiple firm nodules on palpation (Plummer’s
disease)
■ Scintigraphy: hot and normal areas
8. Sub AcuteThyroiditis (SAT)
■ Second common hyperthyroidism – 15%
■ T4 andT3 are extremely elevated in this condition
■ Immune destruction of thyroid due to viral infection
■ Destructive release of preformed thyroid hormone
■ Thyroid gland is painful and tender on palpation
■ Nuclear Scintigraphy scan - no RIU in the gland
■ Treatment is NSAIDs and Corticosteroids
9. Toxic Single Adenoma (TSA)
■ Single hyper functioning follicular thyroid adenoma.
■ Benign monoclonal tumor that usually is larger than
2.5 cm
■ It is the cause in 5% of patients who are thyrotoxic
■ Nuclear Scintigraphy scan shows only a single hot
nodule
■ TSH is suppressed by excess of thyroxines. So the
rest of the thyroid gland is suppressed
10. MedullaryThyroid Carcinoma (MTC)
■ <10% of thyroid carcinomas arises from parafollicular (C) cells and
nearly always secretes calcitonin and sometimes other hormones
■ Associated with syndromes involving tumors of neuroectodermal
origin (multiple endocrine neoplasia – MEN) inherited autosomal
dominantly MEN type 2 (MEN 2)
11. Common Symptoms
■ Excessive Sweating
■ Heat Intolerance
■ Increased Bowel Movements
■ Tremor (Usually Fine Shaking)
■ Nervousness /Agitation
■ Rapid Heart Rate / Palpitations
■ Insomnia
■ Breathlessness
■ Irregular or Scant Menstrual Periods
■ Fatigue
■ Weight Loss (despite increased
appetite)
■ MuscleWeakness
■ Hair Loss
■ irregular heart rhythms and heart
failure / palpitations
■ Psychiatric Symptoms in Graves'
disease:
■ Anxiety, nervousness, fluctuating
moods and irritability
12. Common Signs
■ Hyperactivity / Hyperkinesis
■ Sinus tachycardia or atrial arrhythmia, AF, CHF
■ Systolic hypertension, wide pulse pressure
■ Warm, moist, soft and smooth skin, warm hands
■ Excessive perspiration, palmar erythema, onycholysis
■ Lid lag and stare (sympathetic overactivity
■ Fine tremor
■ Large muscle weakness
■ Gynaecomastia
13. Specific to Graves’ Diseases
■ Diffuse painless and firm enlargement of thyroid gland
■ Thyroid bruit is audible with bell of stethoscpe
■ Ophthalmopathy in 50% cases
– Sand in eyes, periodic edema, conjunctival edema (chemsis),
– Von Graefe's sign (lid lag sign)
– Möbius sign (poor convergence)
– Joffroy sign (absent creases in the forehead on superior gaze)
– Stellwag sign (incomplete and infrequent blinking)
– Extra ocular muscle dysfunction, diplopia, pain on eye movements and proptosis
■ Dermo-acropathy in 20% cases
– Deposition of glycosaminoglycans in dermis of lower leg – non pitting edema, thickening of
skin without pain or pruritus (pre tibial myxedema)
16. Ophthalmopathy in Graves
■ Thyroid associated orbitopathy is thought to be due to antibody reaction against
thyroid stimulating hormone receptor (TSHR) with orbital fibroblast modulation
ofT-Cell lymphocytes
Periorbital edema and chemosis
19. Thyroid Dermopathy
Pink and skin coloured papules, plaques on the shin
Pretibial
myxoedema
• Stimulation of fibroblasts by anti-TSHR antibodies
and production of glucosamnoglycans
22. Non specific changes
■ Hyperglycemia,Glycosuria
■ Osteoporosis and hypercalcemia
■ ↓ LDL andTotal Cholesterols
■ Atrial fibrillation, LVH, ↑ LV EF
■ Hyperdynamic circulatory state
■ High output heart failure
23. Diagnosis – Clinical Clues
■ Hyperthyroidism can be suspected in patients with:
– tremors,
– excessive sweating,
– smooth velvety skin,
– fine hair,
– a rapid heart rate, and
– an enlarged thyroid gland.
24. Diagnosis
1. Typical clinical presentation
2. Markedly suppressedTSH (<0.05 µIU/mL)
3. Elevated FT4 and FT3 (Markedly in Graves)
4. Thyroid antibodies – by Elisa – anti-TPO,TSI
5. ECG to demonstrate cardiac manifestations
6. Nuclear Scintigraphy to differentiate the causes
25. Diagnosis - Labs
■ Blood levels of thyroid hormones can be measured directly and usually
are elevated with hyperthyroidism.
■ Measurement of the bloodTSH levels – which is low
(In secondary hyperthyroidism –TSH levels elevated)
■ Antibody screening (forGraves' disease) and
■ Thyroid scan using radioactively-labelled iodine
26. Diagnosis - Labs
■ LowTSH, High RAIU
– Graves; disease
– Toxic MNG
– Toxic Adenoma
– Chronic gonadotrophin induced
– Inherited non-immune
hyperthyroidism (TSH receptor of
G protein mutation)
• Normal or elevatedTSH
• TSH-secreting pituitary tumors
• Thyroid hormone resistance
higher ratio of FT3 to FT4 suggests that the patient may have
Graves' disease,
28. Issues in Biochemical Evaluation
■ TSH has highest sensitivity and specificity
■ Diagnostic accuracy improves with measurement of freeT4
■ FreeT4 gives baseline measurement of degree of thyrotoxicosis
– Important for monitoring success of initial treatment
– Though not always related to severity of symptoms
■ T3 toxicosis
– Can be sign of early disease
29. 9 Square Interpretation ofThyroid Hormones
High
Normal
Low
Low Normal High
fT4
TSH
PRIMARY
HYPERTHYROIDISM
EUTHYROID
SECONDARY
HYPERTHYROIDISM
PRIMARY
HYPOTHYROIDISM
SECONDARY
HYPOTHYROIDISM
SUBCLINICAL
HYPERTHYROIDISM
SUBCLINICAL
HYPOTHYROIDISM
NONTHYROID
ILLNESS
Or
Pt is onThyroid
Hormones
NONTHYROID
ILLNESS
30. Role of Imaging in Hyperthyroidism
■ Thyroid Ultrasound
– Color Doppler Flow helpful in AIT 1 vs. AIT 2.
– May reveal nodular disease or increased vascularity (seen in Grave’s)
■ Thyroid Uptake & Scan
– High uptake:
■ Graves’, toxic MNG, toxic adenoma
– Low uptake:
■ Thyroiditis, iodine-induced hyperthyroidism
33. DestructiveThyroiditis
Ultrasonography
Doppler US
Graves Disease
Toxic Adenoma
Thyrotoxicosis Suspected
Thyrotoxicosis Confirmed
Detailed history, PE,TSH, FT4,TSH receptor Abs, if needed
Diffuse
hypoechogenicity
or
normoechogenicit
y
(no nodules)
h vascularity Absent or minimal vascularity
Nodular
RAIU and Scan
Toxic MNG Cold Nodule
RAI therapy OR Surgery FNAB
34. Treatment
■ Goals:
– Normalize serumTSH levels
– Reversecorrect clinical signs & symptoms and metabolic derangements.
■ Steps:
– Rest
– Sedation
– Beta-blockers
– Antithyroid medication
– NSAIDs and Corticosteroids – for SAT
– I -131
– Surgery
■ Thyroidectomy – Subtotal orTotal
35. Symptom Relief
■ Rehydration is the first step
■ β – blockers to decrease the sympathetic excess
Propranalol, Atenelol, Metoprolol
valuable during the first 2–3 weeks of treatment in providing
symptomatic relief of tachycardia, nervousness and tremor and can
then be discontinued as the specific antithyroid drug becomes
clinically effective
Rate limiting CCBs if β – blockers contraindicated
36. Symptom Relief
■ Iodinated contrast (Idopate 0.001 μg/kg/day) and
■ Lugol iodine (5% iodine and 10% potassium iodide; 126 mg/mL
iodine, 1 drop 8 hourly) are effective in reversing of features of
hyperthyroidism.
■ Prednisolone (1- 2 mg/kg/day) inhibits peripheral conversion of
T4 toT3 and is useful in treatment of hyperthyroid storm.
■ Treatment of CHF, Arrhythmias
37. Treatment - Medical
■ Methimazole (MMI) – 5-30 mg daily
– Inhibit thyroid hormone synthesis by interfering with the thyroid peroxidase-
mediated iodination of tyrosine residues in thyroglobulin
– Effects seen 1-2 weeks after initiation of therapy.
■ Propylthiouracil (PTU) – 100-300 mg per day divided BID/TID
– PTU can also block the conversion of thyroxine (T4) to triiodothyronine (T3)
■ Side effects:
– Rash, arthralgias, nausea
– Vasculitis
– Liver function tests abnormalities (liver failure with PTU)
– Agranulocytosis
– Embryopathy
Check baseline CBC/diff and LFT’s
38. AntiThyroid Drugs (ATD)
Imp. considerations Methimazole Propylthiouracil
Efficacy Very potent Potent
Duration of action Long acting BID/OD Short acting QID/TID
In pregnancy Contraindicated Safely can be given
Mechanism of action Iodination, Coupling Iodination, Coupling
Conversion ofT4 toT3 No action Inhibits conversion
Adverse reactions Rashes, Neutropenia Rashes, ↑Neutropenia
Dosage 20 to 40 mg/ OD PO 100 to 150mg qid PO
39. How long to give ATD ?
■ Reduction of thyroid hormones takes 2-8 weeks
■ CheckTSH and FT4 every 4 to 6 weeks
■ In Graves, many go into remission after 12-18 months
■ In such pts ATD may be discontinued and followed up
■ 40% experience recurrence in 1 yr. Re treat for 3 yrs.
■ Treatment is not life long. Graves seldom needs surgery
■ MNG andToxic Adenoma will not get cured by ATD.
■ For them ATD is not the best.Treat with RAI.
40. Radio Active Iodine (RAI Rx.)
■ In women who are not pregnant
■ In cases ofToxic MNG andTSA
■ Graves disease not remitting with ATD
■ RAI Rx is the best treatment of hyperthyroidism in adults
■ The effect is less rapid than ATD orThyroidectomy
■ It is effective, safe, and does not require hospitalization.
■ Given orally as a single dose in a capsule or liquid form.
■ Very few adverse effects as no other tissue absorbs RAI
41. Radio Active Iodine (RAI Rx.)
■ I123 is used for Nuclear Scintigraphy (Dx.)
■ I131 is given for RAI Rx. (6 to 8 milliCuries)
■ Goal is to make the patient hypothyroid
■ No effects such asThyroid Ca or other malignancies
■ Never given for children and pregnant / lactating women
■ Not recommended with patients of severe Ophthalmopathy
■ Not advisable in chronic smokers
42. SurgicalTreatment
■ SubtotalThyroidectomy,TotalThyroidectomy
■ HemiThyroidectomy with contra-lateral subtotal
■ ATD and RAI Rx are very efficacious and easy – so Surgical
treatment is reserved for MNG with
1. Severe hyperthyroidism in children
2. Pregnant women who can’t tolerate ATD
3. Large goiters with severe Ophthalmopathy
4. Large MNGs with pressure symptoms
5. Who require quick normalization of thyroid function
43. Treatment – Medical – Beta-blockers
■ Pregnancy- absolute contraindication
■ Graves’ disease – goal is hypothyroidism after treatment
– Fixed dose or calculation (weight [g] x 150 µCi/g x 1/24 hour uptake %)
■ Toxic MNG andToxic Adenoma – can be euthyroid following treatment
■ May repeat in 6 months if initial dose not effective
44. Graves’ Ophthalmopathy
■ Up to 50% may have eye involvement
■ Can be euthyroid or hypothyroid in small minority (< 10 %)
■ High dose steroids
■ Radiation
■ Surgery – orbital decompression
■ Selenium
■ Supportive therapies (lubricants, prisms, etc.)
■ Alternative therapies (e.g. rituximab, botox)
45. Thyroid Storm
■ Life threatening condition associated with untreated hyperthyroidism
■ Dangerously high blood pressure, fever, and heart failure, mental changes, such
as confusion and delirium
■ Precipitating factors may be any major stress such as trauma, infection, etc.
Treatment: 5 Bs
1. Block hormone synthesis: Anti-thyroid drugs
2. Block release: Iodine
3. BlockT4 intoT3 conversion: High dose PTU, steroids
4. Beta-blockers: propranolol
5. Block enterohepatic circulation:Cholestyramine
46. Neonatal Hyperthyroidism
■ Caused by the passage across the placenta of maternal stimulating
antibodies directed against theTRAbs
■ Generally transient, occurring in only about 2% of the offspring of mothers
with GD.
■ Tachycardia, hyperexcitability, poor weight gain contrasting with a normal or
large appetite, small anterior fontanel, advanced bone age,
hepatosplenomegaly
■ Craniostenosis, microcephaly, and psychomotor disabilities may occur in
severely affected infants
■ MMI is preferred (1 mg/kg/day, in three doses). Propranolol (2 mg/kg/day, in
two divided doses) can also be needed to control tachycardia during the first
one to two weeks of treatment.
47. Summary
■ Thyrotoxicosis is a common condition encountered in practice
■ Subclinical disease is more common than overt thyrotoxicosis
■ TSH best for screening and freeT4 for confirmation and monitoring
treatment
■ Radioiodine uptake and scan preferred imaging modality
■ Treatment with methimazole or I-131 usually preferred