Thyrotoxicosis

Intent of Program

Components of Total Serum Thyroxine

Interpretation of Total Serum Thyroxine

Hypothalamic-Pituitary-Thyroid Axis

Interpretation of TSH Level

Variability of the Normal Range for Thyroid Hormone Levels Between Patients

Definition of Thyrotoxicosis Based Upon Level of Circulating Thyroid Hormones

Subclinical Hyperthyroidism

American College of Physicians Position Paper on Screening for Thyroid Disease (hyperthyroidism)*

American College of Physicians Position Paper on Screening for Thyroid Disease (hyperthyroidism) Review by Helfand, M and Redfern, CC*

American College of Physicians Position Paper on Screening for Thyroid Disease (hyperthyroidism) Review by Helfand, M and Redfern, CC*

Subclinical Thyrotoxicosis Rate of Progression or Reversion

Subclinical Thyrotoxicosis Clinical Features

Exogenous Subclinical Thyrotoxicosis Effects Upon Cardiac Morphology and Function

Endogenous Subclinical Hyperthyroidism Effects Upon Quality of Life, Cardiac Morphology and Function

Endogenous Subclinical Hyperthyroidism Effects Upon All-Cause and Cardiovascular Mortality in Elderly

Subclinical Thyrotoxicosis Effects Upon Bone Metabolism and Bone Mineral Density (BMD)

Subclinical Thyrotoxicosis Effects Upon Bone Metabolism and Bone Mineral Density (BMD)

Complications of Subclinical Hyperthyroidism

Euthyroid Hyperthyroxinemia

Euthyroid Hyperthyroxinemia Alterations in Thyroid Binding Globulin (TBG)

Euthyroid Hyperthyroxinemia Increased Total T4 and Normal Free T4

Euthyroid Hyperthyroxinemia Increased Total T4 and Increased Free T4

Euthyroid Hyperthyroxinemia Increased Free T4 and Normal Total T4

Thyrotoxicosis with Normal or Elevated TSH Level

Causes of Thyrotoxicosis Divided by TSH Levels

Differentiation of TSH-Secreting Pituitary Tumor from Inappropriate Secretion of TSH*

Use of Radioiodine Uptake in Differential Diagnosis of Thyrotoxicosis

Causes of Thyrotoxicosis Divided by Radioiodine Uptake

Gravesí Disease in Thyrotoxicosis Laboratory Diagnosis

Hyperthyroidism of Gravesí Disease

Graves' Disease

Observation in Diagnosis of Gravesí Disease and Hyperthyroidism

Clinical Characteristics of Goiter in Gravesí Disease

Goiter in Gravesí Disease

Racial Differences in Ocular Protrusion

Clinical Characteristics of Exophthalmos

Exophthalmos

Clinical Differentiation of Lid Retraction from Proptosis

Lid Lag in Thyrotoxicosis

Lid Lag - Lid Retraction

Extraocular Muscle Imbalance

Extraocular Muscle Impairment in Exophthalmos

Ophthalmologic System in Thyrotoxicosis (including Gravesí Disease)

Clinical Characteristics of Localized Myxedema

Localized Myxedema

Gravesí Disease - Localized Myxedema

Gravesí Disease - Localized Myxedema Other Examples

Thyroid Acropachy

Hyperthyroidism of Gravesí Disease Laboratory Data

Hyperthyroidism of Toxic Adenoma

Hyperthyroidism of Follicular Adenoma Laboratory Data

ìToxicî Nodular Goiter

Hyperthyroidism of Follicular Adenoma

Hyperthyroidism of Colloid (Multinodular) Goiter

ìToxic Multinodular Goiterî

Hyperthyroidism of Colloid (Multinodular) Goiter

Types of Toxic Multinodular Goiter

Thyroid Autoantibodies in Nodular Goiter

Location of Genetic Predisposition to Gravesí Disease and Multinodular Goiter

Frequency of Somatic Mutations That Increase Thyroid Function in Toxic Nodular Goiter*

Activating Thyrotropin Receptor Mutations in Nonadenomatous Hyperfunctioning Nodules of Toxic or Autonomous Multinodular Goiter*

Activating Thyrotropin Receptor Mutations in Nonadenomatous Hyperfunctioning Nodules of Toxic or Autonomous Multinodular Goiter*

Hemorrhage in Toxic Multinodular Goiter

Thyrotoxicosis of Subacute Thyroiditis

Subacute Thyroiditis

Thyrotoxicosis of Subacute Thyroiditis

Types of Subacute Thyroiditis

Differentiation of Subacute Thyroiditis Granulomatous vs. Lymphocytic

Thyrotoxicosis in Thyroiditis

Differential Diagnosis of a Painful Thyroid

Characteristics of Postpartum Thyroiditis

Characteristics of Postpartum Thyroiditis

Biochemical Presentation of PPT*

Clinical Course of Postpartum Thyroiditis

Postpartum Thyroiditis-Clinical Features

Frequency of Postpartum Thyroiditis

Difficulty Differentiating Various Forms of Thyroiditis

Differentiating Types of Thyroiditis* in Thyrotoxicosis

Subacute Thyroiditis and Hashimotoís Thyroiditis

Alternative Progression of Thyroiditis

Possible Stages of Chronic Lymphocytic Thyroiditis

Chronic Lymphocytic Thyroiditis (Hashimotoís Thyroiditis)

Thyroid Autoantibodies in Patients with Chronic Lymphocytic Thyroiditis

Histology of Hashimotoís Thyroiditis

Histology of Lymphocytic Thyroiditis

Prevalence of Celiac Disease in Thyroid Autoimmunity

Prevalence of Celiac Disease in Thyroid Autoimmunity

Rare Types of Thyroiditis Causing Thyrotoxicosis

Slide 91

Slide 92

Bias as to Frequency of Rare Forms of Thyroiditis

Thyroid Scan in Thyrotoxicosis

Chief Complaint in Thyrotoxicosis*

Effects of Age Upon Signs and Symptoms in Thyrotoxicosis

Decreased Symptoms in Thyrotoxicosis of the Elderly

Integumentary System in Thyrotoxicosis

Onycholysis of Thyrotoxicosis

Gastrointestinal System in Thyrotoxicosis

Age and Symptoms of Thyrotoxicosis

Influence of Age Upon Weight and Appetite in Thyrotoxicosis

Cardiorespiratory System in Thyrotoxicosis

Pulse Rate in Thyrotoxicosis

Exertional Symptoms in Thyrotoxicosis

Reproductive System in Thyrotoxicosis

Sex Hormone Levels in Men with Thyrotoxicosis

Reasons for Increased Estradiol Levels in Thyrotoxicosis

Sex Hormone Levels in Men with Thyrotoxicosis

Elevated Gonadotropins in Thyrotoxicosis

Pathophysiology of Hyperestrogenism in Hyperthyroidism

Gynecomastia and Thyrotoxicosis

Why Isnít Gynecomastia Found in all Cases of Thyrotoxicosis?

Clinical Detection of Gynecomastia

Neuromuscular System in Thyrotoxicosis

Clinical Detection of a Tremor

Hyperactive Deep Tendon Reflexes in Thyrotoxicosis

Neuromuscular System in Thyrotoxicosis

Frequency of Neuromuscular Disorders in Thyrotoxicosis

Thyrotoxic Periodic Paralysis

Thyrotoxic Periodic Paralysis

Thyrotoxic Periodic Paralysis

Thyrotoxic Periodic Paralysis

Thyrotoxic Periodic Paralysis

Thyrotoxic Periodic Paralysis

Treatment of Thyrotoxic Periodic Paralysis

Causes of Hypokalemic Periodic Paralysis

Miscellaneous Signs and Symptoms in Thyrotoxicosis

Variable Course of Gravesí Disease

Thyroid Storm Classical Clinical Features

Decompensation of Major Body System

Point Scale for Diagnosis of Thyroid Storm* (>44=highly suggestive, 25-44=suggestive of impending storm, <25=unlikely)

Thyroid Storm - Precipitating Event

Thyroid Storm - Treatment Medication Overview

Thyroid Storm - Treatment Blocking Synthesis

Thyroid Storm - Treatment Blocking Synthesis and Release

Thyroid Storm - Treatment Blocking Peripheral Conversion of T4 to T3

Thyroid Storm - Treatment Removing Circulating Thyroid Hormones

Thyroid Storm - Treatment Beta Adrenergic Blockade

Thyroid Storm - Treatment Miscellaneous Therapeutic Measures

Possible Selective Thyroid Hormone Modulator The Use of L-Carnitine in Thyroid Storm

Treatment of Hyperthyroidism of Gravesí Disease

Treatment of Hyperthyroidism of Gravesí Disease

Treatment of Hyperthyroidism of Gravesí Disease

Argument for a High Initial Dose of I-131Treatment of the Hyperthyroidism of Gravesí Disease

Treatment of Hyperthyroidism of Gravesí Disease

Treatment of Hyperthyroidism of Toxic Single or Multinodular Goiter

Treatment of Thyrotoxicosis of Subacute Thyroiditis

CASE #1

Questions for Case #1

CASE #2

Questions for Case #2