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Hyperthyroidism (overt and mild)

Hyperthyroidism (overt and mild). Manifestations and diagnosis. Graves ophthalmopathy. Graves ophthalmopathy. Graves disease. Localized myxedema of the toe. Thyrotoxic periodic paralysis. Figure 3 Thyrotoxic periodic paralysis pathophysiology hypothesis.

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Hyperthyroidism (overt and mild)

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  1. Hyperthyroidism(overt and mild) Manifestations and diagnosis

  2. Graves ophthalmopathy

  3. Graves ophthalmopathy

  4. Graves disease

  5. Localized myxedema of the toe

  6. Thyrotoxic periodic paralysis

  7. Figure 3Thyrotoxic periodic paralysis pathophysiology hypothesis Maciel, R. M. B. et al. (2011) Novel etiopathophysiological aspects of thyrotoxic periodic paralysis Nat. Rev. Endocrinol. doi:10.1038/nrendo.2011.58

  8. Toxic MNG

  9. Toxic adenoma

  10. Subacutethyroiditis

  11. Symptoms of overt hyperthyroidism • Anxiety • Emotional lability • Weakness • Tremor • Palpitations • Heat intolerance • Increased perspiration • Weight loss despite a normal or increased appetite, gain weight • Hyperdefecation (not diarrhea) • Urinary frequency • Oligomenorrhea or amenorrhea • Gynecomastia • Erectile dysfunction Isolated symptoms and signs: • Unexplained weight loss • New onset atrial fibrillation Myopathy • Menstrual disorders • gynecomastia. • Osteoporosis • Hypercalcemia • Heart failure • Premature atrial contractions • shortness of breath • Deterioration in glycemic control in patients with previously diagnosed diabetes.

  12. Signs of overt hyperthyroidism • Hyperactivity and rapid speech. • Lid retraction and lid lag • warm and moist skin • Thin and fine hair • Tachycardia • Atrial fibrillation • Systolic hypertension may be present • Hyperdynamicprecordium • Tremor • Proximal muscle weakness • Hyperreflexia Only in patients with Graves' disease: 1) Graves ophthalmopathy • Exophthalmos • Periorbital and conjunctival edema • Limitation of eye movement 2) pretibialmyxedema • Infiltrative dermopathy

  13. Diagnosis Low serum TSH High serum T4 and or high serum T3

  14. Mild (subclinical) hyperthyroidism Normal T4 and T3 Suppressed TSH

  15. Subclinical hyperthyroidism • Mild to moderate iodine deficiency • Females • Smokers • Elderly Prevalence in the community in older than 55 yrears: 0.7%-12.4%

  16. Differential diagnosis of subclinical hyperthyroidism • Central hypothyroidism • Nonthyroidal illness • Recovery from hyperthyroidism, including thyroiditis

  17. Subclinical hyperthyroidism Increased risk of mortality : Small Increases with • Age • degree of TSH suppression

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