Hyperthyroidism – Diagnosis And Treatment

Hyperthyroidism – Diagnosis And Treatment

Describe the clinical symptoms, signs and treatment of primary thyrotoxicosis.

Answer.

Primary thyrotoxicosis Symptoms

• Hyperactivity, excitability irritability and dysphoria
• Heat intolerance and swelling
• Palpitations
• Hyperreflxia, muscle wasting proximal myopothy without fasciculations.
• Fatigue and weakness
• Weight loss with increased appetite
• Diarrhea and polyuria.
• Oligomenorrhea and loss of libido.
• Profuse sweating.
• Goitre or enlarged thyroid gland.

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Primary thyrotoxicosis Signs

• Tachycardia is main sign which is present due to activation of
• thyrocardiac component
• Systolic hypertension is present
• Palms are hot and moist.
• Presence of tremors, i.e. involuntary movement of body parts is present.
• Cardiac arrhythmias, i.e. atrial firillation and atrial tachycardia develops.
• Diaphoresis is present, i.e. excessive sweating is present.
• There is presence of powerful wide pulse pressure and good bounding
• pulse is present.
• Exaggerated deep tendon reflxes are seen.
• There is protrusion of eyes, i.e. exophthalmus with staring look.
• Pretibial myxedema: Thickening of skin due to mucin deposition over tibia.

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Primary thyrotoxicosis Treatment

General:

• Allow the patient to take mental and physical rest.
• Maintain nutrition of patient by giving nutritious diet.
• If patient is anxious alprazolam 0.25 to 0.5 mg BD is given.
• Most of the patients of thyrotoxicosis are fearful because ofincreased
• sympathetic activity. In such type of patient, propranolol 40-80 mg BD is given.

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Drug therapy:

• Carbimazole is commonly used drug. It is started with 30 mg/day, adjustment of doses is made when patient come under control and maintenance dose is given,i.e. 10 to 20 mg/day.
• Potassium per chlorate 800 mg/day in divided doses is given and the dose is reduced with improvement in patient’s condition.
• Iodides are given, i.e. sodium or potassium iodide 6 to 10 mg/day.

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Surgery:

• The commonly performed surgery is subtotal thyroidectomy, prior surgery anti-thyroids are given to make patient euthyroid. Potassium iodide 50 to 100 mg/day is given for 10 to 14 days.
• Radioiodine treatment: I131 is used and average effective dose is 8 to 10 millicuries.