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Hyperthyroidism

Hyperthyroidism is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Excessive thyroid hormone production results in a continuum of disease caused by both the direct physiologic effect of thyroid hormones as well as increased catecholamine sensitivity:
    • Subclinical or mild hyperthyroidism
    • Thyrotoxicosis
    • Thyroid storm or thyrotoxic crisis with life-threatening manifestations:
      • 1–2% of patients with hyperthyroidism
  • Regulation of thyroid hormone:
    • Thyrotropin-releasing hormone (TRH) from hypothalamus acts on the anterior pituitary
    • Thyroid stimulating hormone (TSH) released by anterior pituitary gland and results in increased T3 and T4 from the thyroid gland:
      • Most of circulating hormone is T4, which is peripherally converted to T3
      • T3 is much more biologically active than T4 although it has a shorter half-life
  • Genetics:
    • Interplay between genetics and environment
    • Graves disease is associated with HLA-B8 and HLA-DR3
    • Autosomal dominant inheritance seen in some families with nontoxic goiter

Etiology

  • Primary hyperthyroidism:
    • Toxic diffuse goiter (Graves disease)
    • Toxic multinodular (Plummer disease) or uninodular goiter
    • Excessive iodine intake (Jod-Basedow disease)
  • Thyroiditis:
    • Postpartum thyroiditis
    • Radiation thyroiditis
    • Subacute thyroiditis (de Quervain)
    • Chronic thyroiditis (Hashimoto/lymphocytic)
  • Metastatic thyroid cancer
  • Ectopic thyroid tissue (struma ovarii)
  • Pituitary adenoma
  • Drug induced:
    • Amiodarone
    • Lithium
    • α-interferon
    • Interleukin-2
    • Iodine (radiographic contrast agents)
    • Excessive thyroid hormone (factitious thyrotoxicosis)
    • Aspirin overdose

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Citation

Rosen, Peter, et al., editors. "Hyperthyroidism." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307218/all/Hyperthyroidism.
Hyperthyroidism. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307218/all/Hyperthyroidism. Accessed April 25, 2019.
Hyperthyroidism. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307218/all/Hyperthyroidism
Hyperthyroidism [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307218/all/Hyperthyroidism.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hyperthyroidism ID - 307218 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307218/all/Hyperthyroidism PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -