Disorders of the thyroid: Primary hyperthyroidism

Primary Hyperthyroidism

Synthesis and release of excessive thyroid hormone

Etiology and Pathogenesis

Graves disease (idiopathic, autoimmune disorder)

Multinodular goiters

Iodine-induced hyperthyroidism

Thyrotoxicosis factitial

What is Graves disease

An idiopathic autoimmune disease

Most common, don’t know cause, Anti bodies overstimulate TSH receptors

What is Multinodular goiters

A condition where the thyroid gland develops multiple nodules, idiopathic

What is iodine induced hyperthyroidism

Excessive amounts of iodine

Thyrotoxicosis factitial

Ingest increased levels of thyroid hormone

• Treated with thyroid hormone

• Thyroid hormone causes weight loss by inducing catabolism

Clinical signs of primary hyperthyroidism

Tachycardia, Atrial fibrillation, Fine tremors, Proximal muscle weakness, goiter, warm moist skin, hyperreflexia (random contraction)

Hair loss

Clinical symptoms of primary hyperthyroidism

Anxiety

Heat intolerance

• Most clear difference between hyper & hypo thyroidism

Dyspnea or exertion

Palpations

Palmar erythema

Weakness & Fatigue

Weight loss with increased appetite

Diarrhea

Symptoms more specific to graves disease

Thrill on thyroid gland

Ophthalmopathy (eyes bulging)

Thyroid dermopathy

Diagnosis

Suppressed serum TSH with elevated serum free T4

Thyroid peroxidase antibodies

RAIU test

What is thyroid peroxidase antibodies 

Proteins produced by the immune system that mistakenly target thyroid peroxidase

• Indicates graves disease

What is RAIU test

Radioactive iodine uptake

Radionuclide scan

• Over used iodine