What is thyrotoxicosis?
- another word for hyperthyroidism
- result of tissues exposed to excess T4, T3 or both
- occurs more frequently in women
Clinical Presentation of HyperT
- nervousness, emotional lability
- easy fatiguability
- heat intolerance
- weight loss w/ increased appetite, anorexia in elderly, increased frequency of bowel movements
- palpitations
- irregular or scant menses
What are the therapeutic goals for hyperT treatment?
- relive sxs
- reduce thyroid hormone production to normal levels and achieve biochemical euthyroidism
- prevent long-term adverse sequelae
What are the 2 primary agents used in hyperT treatment?
- methimazole
- propylthiouracil
AEs of Antithyroid Agents
- minor: pruritic maculopapular rash, arthralgia, fever, benign transient leukopenia
- major: agranulocytosis, arthralgia, lupus-like syndrome, GI intolerance, hepatotoxicity
What is 1st line hyperT treatment?
-beta blockers
When are iodides used for hyper T treatment?
- rapid decrease in thyroid levels
- used pre-operatively when other meds are ineffective or CI
- can also be used during pregnancy
- can also be used with antithyroid agents
What are common side effects of iodides?
- salivary gland inflammation
- conjunctivitis
- acne-form rash
What are common side effects of iodides?
- salivary gland inflammation
- conjunctivitis
- acne-form rash
What is the treatment of choice for Grave’s disease?
radioactive iodine
What is a drawback of tx with radioactive iodine?
-destroys thyroid tissue –> pts become hypothyroid and will need levothyroxine long term
What is a drawback of tx with radioactive iodine?
-destroys thyroid tissue –> pts become hypothyroid and will need levothyroxine long term
When is radioactive iodine tx CI?
-pregnancy or breastfeeding
AEs of Radioactive Iodine
- transient neck soreness
- flushing
- decreased taste
AEs of Radioactive Iodine
- transient neck soreness
- flushing
- decreased taste
Advantages of Antithyroid Drugs for Grave’s Disease
- noninvasive
- lower initial cost
- low risk of permanent hypoT
Disadvantages of Antithyroid Drugs for Grave’s Disease
- low cure rate
- adverse drug reactions
Advantages of Radioactive Iodine for Grave’s Disease
- curative
- most cost effective
Disadvantages of Radioactive Iodine for Grave’s Disease
- permanent hypothyroidism
- delay pregnancy 6-12 months
Advantages of Thyroidectomy for Grave’s Disease
-rapid, effective treatment
Disadvantages of Thyroidectomy for Grave’s Disease
- most invasive
- most costly
- permanent hypothyroid
- pain, scar
What is required before surgery is done?
-pt must be euthyroid
Sxs of Thyroid Storm
- high fever
- tachycardia, tachypnea
- dehydration
- delirium, coma
- GI disturbances
Tx of Thyroid Storm
- short acting beta blocker
- IV or oral iodide
- large doses of propylthiouracil
- supportive care: APAP for fever, fluid and electrolyte management
- IV hydrocortisone due to potential presence of adrenal insufficiency
