1. Symptoms

• nervousness (64%)
• heat intolerance (45%)
• weight loss (37%)
• irritability (32%)
• fatigue (27%)
• restless sleep (27%)
• palpitation (17%)
• decreased attention span (13%)
• diarrhea (10%)
• insomnia (7%)
• menstrual irregularities (6%)

2. Signs

• tachycardia (64%)
• tremor (50%)
• warm, moist skin (36%)
• muscle weakness (25%)
• eye lag (22%)
• eye retraction (16%)
• systolic hypertension (6%)
• growth acceleration

1. Thyroid scan (131 Radioiodine)

• Graves' - diffuse increased uptake
• Hashimoto's - patchy increased uptake
• Subacute - poor untake

2. Others

• CT, MRI

1. Thioureylenes

• propylthiouracil, carbimazole, methimazole
• block action of thyroid peroxidase - iodination of thyroglobulin
• may also inhibit the conversion of T3 -> T4
• deplete thyroid hormone stores within 6-12 months
• effect is slow but avoids surgery or radiation
• prolonged treatment is often required (4.5 years)
• 50% relapse rate after 2 years
• 20% relapse rate after 10 years
• problems with end point - ? hypothyroid, ? euthyroid
• SE: bone marrow suppression - granulocytopenia, agranulocytosis, arthritis, liver disease, rash, nephrotoxic

2. Antihypertensives

• propranolol
• beta-blocker contraindicated in asthmatics
• use until thyroid hormone normalizes

1. 131I

• beta-radiation from 131I directly damages thyroid tissue
• radiation thyroiditis -> endarteritis -> interstitial fibrosis -> thyroid tissue atrophy
• usually treatment of choice
• 98% effective with only 1% relapse rate
• euthyroid within 6 weeks and hypothyroid within 3 months
• most will need life long thyroxine replacement
• complications:
  • no evidence of genetic damage or tumogenesis
  • 6% parathyroid dysfunction
  • thyroid storm

1. Thyroidectomy

• indicated for medical failure to control hyperthyroid condition in pregnancy
• best to perform during the 2nd trimester
• only a 3% recurrence rate
• complications:
  • hypothyroidism (32%)
  • hypoparathyroidism
  • injury to the recurrent laryngeal nerve