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Chapter 229: Hyperthyroidism

Alzamani Mohammad Idrose

INTRODUCTION AND EPIDEMIOLOGY

Thyroid hormone affects all organ systems and is responsible for increasing metabolic rate, heart rate, and ventricle contractility, as well as muscle and central nervous system excitability. Two major types of thyroid hormones are thyroxine and triiodothyronine. Thyroxine is the major form of thyroid hormone. The ratio of thyroxine to triiodothyronine released in the blood is 20:1. Peripherally, thyroxine is converted to the active triiodothyronine, which is three to four times more potent than thyroxine.

Hyperthyroidism refers to excess circulating hormone resulting only from thyroid gland hyperfunction, whereas thyrotoxicosis refers to excess circulating thyroid hormone originating from any cause (including thyroid hormone overdose).

Thyroid storm is the extreme manifestation of thyrotoxicosis. This is an acute, severe, life-threatening hypermetabolic state of thyrotoxicosis caused either by excessive release of thyroid hormones causing adrenergic hyperactivity or altered peripheral response to thyroid hormone following the presence of one or more precipitants.

The mortality of thyroid storm without treatment is between 80% and 100%, and with treatment, it is between 15% and 50%.

Primary hyperthyroidism is caused by the excess production of thyroid hormones from the thyroid glands. Secondary hyperthyroidism is caused by the excess production of thyroid-releasing hormones or thyroid-stimulating hormones in the hypothalamus and pituitary, respectively (Tables 229–1 and 229–2).

Table 229–1

Causes of Hyperthyroidism: Primary and Secondary Hyperthyroidism

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Table 229–1

Causes of Hyperthyroidism: Primary and Secondary Hyperthyroidism
Primary Hyperthyroidism
Graves' disease (toxic diffuse goiter) (Figure 229–1)

Most common of all hyperthyroidism (85% of all cases)

Associated with diffuse goiter, ophthalmopathy, and local dermopathy
Toxic multinodular goiter Second most common cause of hyperthyroidism
Toxic nodular (adenoma) goiter (Figure 229–2) An enlarged thyroid gland that contains a small rounded mass or masses called nodules with overproduction of thyroid hormone
Thyroiditis Inflammation of the thyroid gland
Hashimoto's thyroiditis Initially gland is overactive (hyperthyroidism state), but this is usually followed by a state of hypothyroidism
Subacute painful thyroiditis (de Quervain's thyroiditis)
Subacute painless thyroiditis
Radiation thyroiditis
Secondary Hyperthyroidism
Thyrotropin-secreting pituitary adenoma Thyroid gland stimulated to produce hormones
Table 229–2

Other Causes of Hyperthyroidism

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Table 229–2

Other Causes of Hyperthyroidism
Nonthyroidal Disease
Ectopic thyroid tissue (struma ovarii)/teratoma A rare form of mature teratoma that contains mostly thyroid tissue
Metastatic thyroid cancer Stimulates production of thyroid hormones
Human chorionic gonadotropin Secreting hydatidiform mole
Drug Induced
Iodine

Iodine-induced thyrotoxicosis (called Jod-Basedow disease)

After treatment of endemic goiter patients with iodine or stimulation of thyroid hormones from use of iodine-containing agents such as radiographic contrast agents
Amiodarone Contains iodine; may cause either thyrotoxicosis or hypothyroidism

α-Interferon

Interleukin-2

 During treatment for other diseases, such as viral hepatitis and human immunodeficiency virus infection
Thyrotoxicosis factitia Munchausen-like; thyroid hormone is taken by patient to fake illness
Ingestion of meat ...

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