Hyperthyroidism diagnosis

Schilling JS. Hyperthyroidism diagnosis and management of Graves disease. Nurse Pract 1997 22 72. 

O In most patients with thyroid hormone disorders, the measurement of a serum thyroid-stimulating hormone (TSH) level is adequate for the diagnosis of hypothyroidism and hyperthyroidism. The target TSH for most patients being treated for thyroid disorders should be the mean normal value of 1.4 milliunits/L or 1.4 microunits/mL (target range 0.5-2.5 milliunits/L or 0.5-2.5 microunits/mL). 

Peptides in Human Urine (Skarzynski and Samecka-Keller), 5, 107 Protein Bound Iodine (Chaney), I, 82 Radioactive Iodine-131 in the Diagnosis of Hyperthyroidism, Blood Plasma Levels of (Silver), 1, 111 Transaminase Activities of Serum and Body Fluids, the Clinical Significance of Alterations in (Wroblew-ski), 1, 314... 

A diagnosis of hyperthyroidism was made but the bone symptoms prompted further investigation whilst Mrs Grant was an inpatient. 

Blood Plasma Levels of Radioactive Iodine-131 in the Diagnosis of Hyperthyroidism Solomon Silver... 

E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism). Note Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of bipolar I disorder. 

In a retrospective review of 497 patients taking propylthiouracil for hyperthyroidism, clinically overt hepatitis developed in six patients at 12-49 days after starting the drug (50). Jaundice and itching were present in five, fever in two, rash in two, and arthralgia in one. Serum bilirubin, alanine transaminase, and alkaline phosphatase were increased in five, four, and six patients respectively. The type of hepatic injury was cholestatic in three, hepatocellular in one, and mixed in two. There were no differences in age, sex, drug dose, or serum thyroid hormone concentrations at time of diagnosis in those with hepatic injury compared with those without. Liver function normalized in all patients at 16-145 days after withdrawal of propylthiouracil. In addition to these cases of overt liver injury, 14% of the cohort had mild asymptomatic liver enzyme rises at a mean of 75 days after the start of treatment. 

The authors attributed these changes to an effect of amiodarone, but it is not clear that amiodarone-induced changes would have taken so long to become manifest after withdrawal. However, the diagnosis of type 2 amiodarone-induced hyperthyroidism was supported by a poor response to prednisone, potassium perchlorate, and methimazole. Lithium produced temporary benefit, but thyroidectomy was required. 

A major type of headache that must be considered in differential diagnosis is that caused by underlying disease intracranial disturbances (e.g., vascular anomalies, infections, tumors, trauma) diseases involving the head and neck but not the brain (e.g., cervical osteoarthritis disorders of eye, ear, nose, sinuses, and throat cranial neuralgias) and systemic diseases (e.g., sudden and severe hypertension, hyperthyroidism). These headaches usually can be relieved by specific therapy for the underlying disorder (e.g., surgical correction of tumors, antibiotics for infections, antiarthritic drugs for osteoarthritis). 

Clinically, the practitioner may observe conjimctival chemosis and erythema, abnormal eyelid position (lid retraction), lid lag, and proptosis. Conjunctival injection is most marked over the involved rectus muscles. Nervousness, palpitations, weight loss, hyperhidrosis, and heat intolerance are systemic symptoms occurring in more than 80% of hyperthyroid patients. Other signs, such as tremor, hyperreflexia, tachycardia, skin changes, stare, and eyelid lag, are observed in more than 60%. Additionally, goiter is present in more than 95% of Graves disease patients. In most cases, however, the laboratory confirmation of thyrotoxicosis is helpful to corroborate the diagnosis. 

Graves ophthalmopathy develops in more than 80% of cases within 6 months of the diagnosis of Graves hyperthyroidism. Graves ophthalmopathy may occasionally develop before the diagnosis of hyperthyroidism. Thyroid-related orbitopathy is associated with Graves hyperthyroidism in 90% of cases and with autoimmime thyroiditis (Hashimoto s disease) in some 5%. No laboratory evidence of thyroid disease is fiaimd in 5% to 10% of patients. This condition is called ophthalmic or euthyroid Graves ophthalmopathy. 

Xe 5.25 d r (346) 7 (81) kidneys) Therapy (hyperthyroidism, thyroid cancer) Diagnosis (lung, brain)... 

It is probable that no patient is wholly refractory to these drugs. Failure to respond is likely to be due to the patient not taking the tablets or to wrong diagnosis. The drugs are used in hyperthyroidism as... 

Radioiodine uptake can be used to test thyroid function, though technetium would be more usual. Scanning may be used for the identification of solitary nodules, and in the differential diagnosis of Graves disease from the less common thyroiditides (e.g. de Quervain s thyroiditis). In the latter, excessive thyroid hormone release caused by follicular cell damage can cause clinical and biochemical features of hyperthyroidism, but uptake is reduced. 

The treatment of hyperthyroidism due to Graves disease is either 12 months treatment with carbimazole or propylthiouracil or a single diagnosis of 1.These drugs do not have a place in the 5 10% of patients in whom thyrotoyicosis is due to a toyic adenoma or to subacute thyroiditis. 

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