Thyrotoxicosis clinical presentation

The clinical, biochemical, and thyroid imaging characteristics of thyrotoxicosis resulting from interferon alfa treatment have been retrospectively analysed from data on 10 of 321 patients with chronic hepatitis (75 with chronic hepatitis B and 246 with chronic hepatitis C) who developed biochemical thyrotoxicosis (505). Seven patients had symptomatic disorders, but none had ocular symptoms or a palpable goiter. Six had features of Graves disease that required interferon alfa withdrawal in four and prolonged treatment with antithyroid drugs in all six. Three presented with transient thyrotoxicosis that... 

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. 

The most severe form (f hyperthyroidism is thyroid storm, a rare but life-threatening disease that usually is precipitated by an intercurrent medical problem. Precipitating factors include infections, stress, trauma, thyroidal or nonthyroidal surgery, diabetic ketoacidosis, labor, heart disease, and rarely, radioactive iodine ablation. Clinical features are similar to those of thyrotoxicosis, but are more severe. Cardinal features include fever and tachycardia out of proportion to the fever. Nausea, vomiting, diarrhea, agitation, and confusion are frequent presentations. The abnormalities in TFTs are not necessarily worse than those in uncomplicated thyrotoxicosis and thyroid storm is a clinical diagnosis. 

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