HYPERTHYROIDISM AND

HYPOTHYROIDISM
N NNNNNNNNIDHI S KRISHNA
HYPERTHYROIDISM/
THYROTOXICOSIS

 Thyrotoxicosis refers to biochemical and

physiological manifestation of excessive
thyroid hormones

 Where as in hyperthyroidism the pathology

lies in the thyroid gland.
Etiology

 Graves disease
 Toxic adenoma
 Toxic multinodular goitre
 Thyroiditis
 Also occur due to other causes :
 Ectopic functioning thyroid
 Struma ovarii
 Thyrotoxicosis factitia
 Jod Basedow thyrotoxicosis
 Drug induced hyperthyroidism
Graves disease/ Diffuse
thyroid goitre
 Usually seen in young women
 The whole of the functioning thyroid tissue is
involved and the hypertrophy and
hyperplasia are due to abnormal thyroid
stimulating antibodies ( TSH-RAb) that binds
to TSH receptor sites and produce a
disproportionate and prolonged effect
 It can be familial
 An infiltrative ophthalmopathy accompanies
Graves disease in about 50 % of patients.
picture
Toxic adenoma

 Pathophysiology
 Autonomous hormone production
 Usually seen in middle aged and elderly
 In many cases the nodules are solitary,
inactive and non tender
Toxic multinodular goiter

 Pathophysiology
Also known as Plummers disease

 Autonomous hormone production

 Insidious onset
 Second common cause of hyperthyroidism
 Most common in women
 Higher T3 than T4
 One or more nodules
 Tender
Thyroiditis

Inflammation of the thyroid gland

 Pathophysiology
 Leakage of hormone from the gland
 Gland size is moderately increased
 Tender
Clinical features

Symptoms
 Symptoms of primary thyrotoxicosis are
mainly associated with the nervous system
and that of secondary thyrotoxicosis are
cardiac manifestations
 Cardiovascular system
 Palpitations
 Shortness of breath
 Angina
 Cardiac failure in the elderly
 Gastrointestinal system
 Weight loss in spite of increased appetite
 Diarrhoea
 Neuromuscular system
 Fatigue and muscle weakness
 Tremor

 Skeletal system
 Increase in linear growth in children
 Genitourinary system
 Oligemenorrhoea or amenorrhoea
 Occasional urinary frequency
 Psychiatry
 Irritability
 Nervousness
 Insomnia
 Integument
 Hair loss
 Gynaecomastia
 Pruritus
 Palmar erythema
 Signs
 Eye signs
 Cardiac manifestations
 Myopathy
 Pre-tibial myxoedema
 Thyroid acropathy
 Other
 Signs
 Eye signs
Common in primary toxicosis
(i) Lid retraction: Upper eyelid is higher than
the lower eyelid due to the overactivity of the
involuntary part of levator palpabrae
superioris muscle.
(ii) Exophthalmos : Proptosis of eye
-Both upper and lower eyelids are away from
the centre with visible sclera all around
mainly below
- Severe ;
* Eyelid edema, conjuctival injection
* Corneal ulceration
* Finally may also cause loss of vision
 Eye signs

 Von graffe’s sign- Upper eyelid lags behind

the eyeball

 Joffroy’s sign- Absence of wrinkling on the

forehead when the patient looks upwards
 Stellwag’s sign- appears first
- Absence of normal blinking
- Due to widening of palpebral fissure
 Moebiu’s sign : Severe
- Inability to converge the eyeballs
- Due to lymphocytic of inferior oblique and
rectus muscles
- Diplopia
- May be an eventual sign of eventual
ophthalmoplegia
 Dalrympte’s sign : Upper sclera is visible due
to retraction of eyelid

(iii) Ophthalmoplegia- Weakness of ocular

muscles due to edema or cellular infiltrates
(iv) Chemosis – edema of conjuctiva and
becomes thickened and crinkled
 Cardiac manifestations
 Tachycardia is common
 Wide pulse pressure
 Paroxysomal atrial fibrillation
 Pulsus paradoxus
 Myopathy
 Weakness of proximal muscle occurs
 Weakness is more when muscle contracts
isometrically
 Pretibial myxoedema
- Often a feature of primary thyrotoxicosis
- Is usually bilateral, symmetrical, shiny, red
thickened dry skin with coarse hair in the feet
and ankles
- Due to deposition of myxomatous tissues in
skin and subcutaneous plane
Differences of hyper and
HYPOTHYROIDISM

 Decreased production of thyroid hormone

 Cretinism
 Inadequate production during fetal and
neonatal development.
 Endemic cretinism is due to iodine deficiency

 Adult Hypothyroidism
 Mild deficiency of the hormone
Symptoms
 Tiredness
 Mental lethargy
 Cold intolerance
 Weight gain
 Constipation
 Menstrual disturbance
Signs
 Bradycardia
 Dry skin and hair
 Periorbital puffiness
 Hoarse voice
 Bradykinesis
 Myxoedema
The signs and symptoms of hypothyroidism
are accentuated
 Typical facial appearance and there is supra
clavicular puffiness
 Malar flush
 Yellow tinge to the skin
 Myxodema coma : Characterized by altered
mental state, hypothermia etc

 Primary or atrophic myxodema :

Autoimmune disease similar to thyroiditis but
with no goitre formation
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