Hyperthyroidism

Epidemiology

  • xxx

Physiology

  • xx

Diagnosis

  • Hyperferritinemia
  • xxx

Clinical

Pulmonary Manifestations

Pulmonary Hypertension (see Pulmonary Hypertension, [[Pulmonary Hypertension]])

  • The association between thyroid diseases (hypothyroidism and hyperthyroidism) and PH has been reported in a number of studies (127,128). In a recent prospective study using echocardiographic evaluation, more than 40% of patients with thyroid diseases had PH (129)
  • One instance of PVOD confirmed by histology was observed in a patient with Hashimoto thyroiditis (130).
  • Interestingly, a recent prospective study of 63 consecutive adult patients with PAH found a 49% prevalence of autoimmune thyroid disease, including both hypothyroidism and hyperthyroidism, suggesting that these conditions may be linked by a common immunogenetic susceptibility (131)

Acute/Chronic Hypoventilation (see Acute Hypoventilation, [[Acute Hypoventilation]] and Chronic Hypoventilation, [[Chronic Hypoventilation]])

Cardiac Manifestations

  • xxx

Hematologic Manifestations

  • Anemia (see Anemia, [[Anemia]])

Treatment

References

  • 127 Li JH, Safford RE, Aduen JF, Heckman MG, Crook JE, Burger CD. Pulmonary hypertension and thyroid disease. Chest 2007;132:793–7
  • 128 Ferris A, Jacobs T, Widlitz A, Barst RJ, Morse JH. Pulmonary
    arterial hypertension and thyroid disease. Chest 2001;119:1980–1
  • 129 Mercé J, Ferra ́s S, Oltra C, et al. Cardiovascular abnormalities in hyperthyroidism: a prospective Doppler echocardiographic study. Am J Med 2005;118:126–31.
  • 130 Kokturk N, Demir N, Demircan S, et al. Pulmonary veno-occlusive disease in a patient with a history of Hashimoto’s thyroiditis. Indian J Chest Dis Allied Sci 2005;47:289–92.
  • 131 Chu JW, Kao PN, Faul JL, Doyle RL. High prevalence of autoimmune thyroid disease in pulmonary arterial hypertension. Chest 2002;122:1668 –73

Thyrotoxicosis

Epidemiology

  • xx

Etiology

Inadequately-Treated Grave’s Disease

  • Precipitants:
    • Sepsis:
    • Medical Illness:
    • Iodine Load-Contrast:
    • Post-Thyroidal Surgery:
    • Post-Non-Thyroidal Surgery:
    • Exogenous Thyroid Intake:
    • Toxic Nodular Goiter:
    • Thyroiditis:
    • Thyroid Adenoma:
    • Thyroid Cancer:

Diagnosis

  • TFT’s:
    • TSH: decreased
    • Free and total T4: increased
    • Free and total T3: increased (usually more than serum T4)

Clinical

  • Neuro
    • Irritability:
    • Delirium:
    • Coma:
    • Fever:
    • Hyperreflexia:
  • Cardiac
    • Tachycardia:
    • Hypotension:
    • High-Output CHF:
  • GI
    • Vomiting:
    • Diarrhea:

Treatment

Supportive Care

  • Hydration:
  • B-complex vitamins:
  • Digoxin (for AF):

Therapy #1: Beta-Blockers

  • Propanolol is the best studied, but Esmolol is also effective
  • Propanolol blocks beta receptors, as well as partially inhibiting conversion of T4->T3
  • Relief of symptoms usually occurs within minutes
  • Useful if CHF is absent

Therapy #2: PTU (100 mg every 2 hours PO) or Methimazole

  • Effect may take weeks
  • Blocks T4 and T3 synthesis (within 2 hrs), as well as peripheral conversion of T4->T3

Therapy #3: Potassium Iodide (SSKI) or Lugol Solution

  • Works almost immediately
  • Give at least 1 hr after beta blockers + PTU to prevent iodine from being used as substrate by hyperfunctioning gland
  • Blocks hormone release and peripheral conversion

Therapy #4: Dexamethasone (2 mg IV q6 hours)

  • Aids decreased adrenal reserve that may be present, inhibits hormone release, and inhibits peripheral conversion from T4 to T3

Clinical Course

  • With treatment with PTU, iodide, and dexamethasone, T3 usually returns to normal within 24-48 hrs