HYPERTHYROIDISM

1. Definition

Hyperthyroidism is a condition in which the thyroid gland produces and releases excess
amounts of thyroid hormones — Triiodothyronine (T3) and Thyroxine (T4) — into the
bloodstream, causing an overactive metabolism.

• Reason: Thyroid hormones control metabolism, heart rate, and energy balance.
Excess levels overstimulate body systems, leading to symptoms affecting almost
every organ.

2. Risk Factors (with reasons)

Risk Factor Reason

Women are 5–8 times more likely to develop autoimmune thyroid

Female gender disorders like Graves’ disease due to hormonal and immune system
differences.

Family history of Genetic predisposition increases likelihood of autoimmune thyroid

thyroid disease disorders.

Peak onset of autoimmune thyroid diseases occurs in young

Age 20–40 years
adulthood.

Personal history of Conditions like type 1 diabetes or rheumatoid arthritis share

autoimmune disease immune system abnormalities that can target the thyroid.

Iodine is essential for thyroid hormone production; excessive

Excess iodine intake
intake can overstimulate the gland.

Radiation exposure to
Radiation damages thyroid cell DNA, altering hormone regulation.
neck

Increases risk of Graves’ ophthalmopathy due to immune system

Smoking
stimulation.

3. Etiological Factors (with reasons)

Cause Reason

Graves’ disease (most Autoimmune antibodies mimic TSH, causing continuous

common) stimulation of thyroid hormone release.
Cause Reason

Multiple nodules produce excess hormones independent of

Toxic multinodular goiter
TSH control.

A benign tumor produces thyroid hormones without

Thyroid adenoma
regulation.

Inflammation damages follicles, releasing stored hormones

Thyroiditis
into the bloodstream.

Excessive iodine intake Activates overproduction in susceptible thyroid tissue.

Excessive thyroid hormone Overdose or inappropriate therapy leads to iatrogenic

medication hyperthyroidism.

Pituitary adenoma (rare) Produces excess TSH, overstimulating the thyroid.

4. Signs & Symptoms (with reasons)

Sign/Symptom Reason

Weight loss despite increased Excess T3/T4 increases basal metabolic rate, burning
appetite calories faster.

Heat intolerance Increased metabolism raises heat production.

Sweating Hypermetabolism stimulates sweat glands.

Palpitations / tachycardia Thyroid hormones increase heart rate and contractility.

Nervousness / anxiety Excess hormones stimulate the nervous system.

Tremors Overstimulation of neuromuscular activity.

Goiter Thyroid enlargement due to overstimulation.

Exophthalmos (in Graves’ Autoimmune reaction causes inflammation and swelling

disease) behind the eyes.

Increased bowel movements /

Increased gut motility due to sympathetic stimulation.
diarrhea

Hormonal imbalance disrupts reproductive hormone

Menstrual irregularities
regulation.

Hair thinning Rapid hair cycle turnover due to metabolic acceleration.

Muscle weakness Protein breakdown from increased metabolism.

5. Diagnostic Tests – Procedures & Normal Values

A. Serum T3 Test

• Normal value: 80–200 ng/dL

• Procedure (10 steps):

1. Explain procedure to patient to reduce anxiety.

2. Verify fasting status if required by lab protocol.

3. Position patient comfortably, usually sitting.

4. Apply tourniquet above venipuncture site.

5. Clean site with antiseptic solution.

6. Insert sterile needle into vein.

7. Draw required blood sample.

8. Release tourniquet before removing needle.

9. Apply pressure and sterile dressing.

10. Send labeled sample to lab promptly.

B. Serum T4 Test

• Normal value: 5–12 μg/dL

• Procedure: Same 10 steps as above.

C. Serum TSH Test

• Normal value: 0.4–4.0 mIU/L

• Reason in hyperthyroidism: Low TSH due to negative feedback (except in pituitary

adenoma).

• Procedure: Same as above.

D. Thyroid Antibody Test

• Normal value: Negative or low titers.

• Reason: Detects autoimmune causes like Graves’ disease.

• Procedure: Same 10 steps as above.

E. Radioactive Iodine Uptake (RAIU) Test

• Normal value: 10–30% at 24 hours.

• Procedure (10 steps):

1. Explain purpose: measures iodine uptake by thyroid.

2. Ensure no iodine-containing drugs are taken for 1–2 weeks prior.

3. Check pregnancy status (contraindicated).

4. Give small dose of radioactive iodine orally.

5. Wait for prescribed time (usually 6 and 24 hours).

6. Position patient in front of gamma probe.

7. Measure radiation emitted from thyroid area.

8. Record percentage uptake.

9. Advise hydration to aid iodine excretion.

10. Provide radiation safety instructions.

F. Thyroid Scan

• Normal finding: Uniform uptake pattern.

• Procedure: Same initial prep as RAIU but images taken using a gamma camera.

6. Complications (with reasons)

Complication Reason

Sudden surge in thyroid hormones → hypermetabolic

Thyrotoxic crisis (thyroid storm)
state → fever, tachycardia, delirium.

Persistent tachycardia and high cardiac output strain the

Heart failure
heart.

Osteoporosis Excess hormones increase bone resorption.

Atrial fibrillation Overstimulation of the heart’s conduction system.

Vision loss (severe Graves’

Optic nerve compression from swelling.
ophthalmopathy)

7. Medical Management (detailed with reasons)

Treatment Reason & Details

Inhibit thyroid hormone synthesis by blocking iodine

Antithyroid drugs (Methimazole,
binding. PTU also blocks peripheral conversion of T4 to
Propylthiouracil/PTU)
T3.

Beta-blockers (Propranolol, Control symptoms like tachycardia, tremors, anxiety by

Atenolol) blocking adrenergic effects.

Destroys overactive thyroid cells, reducing hormone

Radioactive iodine therapy
production.

Temporarily inhibits hormone release; used

Iodine solution (Lugol’s iodine)
preoperatively to reduce gland vascularity.

Glucocorticoids Reduce inflammation in Graves’ ophthalmopathy.

High-calorie, high-protein diet Compensates for increased metabolic demand.

8. Surgical Management (detailed with reasons)

Indications:

• Large goiter causing airway compression

• Suspicion of cancer

• Patient unable to tolerate medical therapy

• Severe Graves’ disease

Types:

• Subtotal thyroidectomy – removal of most of the gland.

• Total thyroidectomy – complete removal.

Preoperative Care (with reasons):

1. Euthyroid state with antithyroid drugs – reduces risk of thyroid storm.

2. Iodine drops for 10–14 days – reduce gland size and vascularity.

3. Nutritional optimization – prevent postoperative healing delay.

4. Breathing exercises – prepare for post-op discomfort.

5. Voice assessment – baseline to detect recurrent laryngeal nerve injury later.

Intraoperative Considerations:

• Maintain airway security.

 • Avoid injury to parathyroid glands and recurrent laryngeal nerve.

Postoperative Care (with reasons):

1. Monitor airway patency – swelling can cause obstruction.

2. Semi-Fowler’s position – reduces neck swelling.

3. Check for bleeding behind neck – hematoma risk.

4. Monitor calcium levels – hypocalcemia may occur if parathyroids are

removed/damaged.

5. Voice checks – detect nerve injury.

6. Pain management – promotes early mobilization.

7. Thyroid hormone replacement – if total thyroidectomy done.