1. HYPERTHYROIDISM
By,
Pranav Khawale,
BNYS(2nd Year)

2. CONTENTS
• Definition
• Etiopathogenesis
• Clinical features
• Risk Factors
• Signs and Symptoms
• Differential Diagnosis
• Diagnosis

3. DEFINITION
• Hyperthyroidism occurs when the thyroid
gland produces excessive amounts of thyroid
hormone

4. ETIOPATHOGENESIS
• Hyperthyroidism may be caused by many diseases but
three most common causes are:
1. Grave’s disease
2. Toxic multinodular goitre
3. Toxic adenoma
• Hypersecretion of pituitary TSH by a pituitary tumor
• THR hypersecrection
• Thyroiditis
• Metastatic tumor of thyroid

5. CLINICAL FEATURES
• Emotional instability
• Nervousness
• Palpitation
• Fatigue
• Weight loss
• Perspiration
• Menstrual disturbances
• Skin is warm
• Weakness of skeletal muscles
• Osteoporosis is common

6. RISK FACTORS
• Age between 20 and 40 years
• Stress
• Pregnancy
• In newborns, a mother with Graves' disease
• Intestinal dysbiosis
• Antibiotic overusage
• Family history

8. SIGNS AND SYMPTOMS
• Tachycardia
• Tachyarhythmia/palpitations
• Bruit over thyroid gland
• Hypertension
• Swelling at the base of the neck
• Moist skin and increased perspiration
• Shakiness and tremor
• Nervousness

9. • Confusion
• Increased appetite accompanied by weight loss
• Difficulty in sleeping
• Swollen, reddened, and bulging eyes
• Constant stare (infrequent blinking, lid lag)
• Sensitivity of eyes to light
• In thyroid storm: fever, very rapid pulse,
agitation, and possibly delirium
• Altered menses

10. DIFFERENTIAL DIAGNOSIS
• Depression
• Anxiety
• Hyperactivity
• Neurologic disease with resultant tremor
• Heart disease
• Drugs

11. DIAGNOSIS
• Physical Examination
• Laboratory Tests
o Serum thyroxine (T4) assay
o Serum triiodothyronine (T3) assay

12. • Other Diagnostic Procedures
o Perform a radioactive iodine uptake test
o Radioactive iodine uptake tests indicate the source of the
overstimulation that results in the disease
o Thyroid ultrasound

13. GRAVES’ DISEASE
Graves’ disease also known as
Basedow’s disease

14. GRAVES’ DISEASE
• Most common cause of thyrotoxicosis
• TSH-R antibody (stim)
• Goitre, Orbitopathy, Dermopathy
• This disease is more frequently between the
age of 30 and 40 years
• and has increased prevalence in females

15. ETIOPATHOGENESIS
• Graves’ disease is an autoimmune disease
• HLA association- graves’ disease has genetic
predisposition
• Autoimmune disease association-graves’
disease may be found in association with
other organ-specific autoimmune diseases
• Other factor-emotional stress and smoking

16. • In patients with Grave’s disease, eye signs may
precede, coincide with or follow the
hyperthyroidism
• Sometimes similar eye signs are seen without
a detectable thyroid abnormality

17. Pathology
Activated T cells infiltrate orbital contents
and stimulate fibroblasts, leading to:
1. Enlargement of extraocular muscles
2. Cellular infiltration of interstitial tissues
3. Proliferation of orbital fat and connective
tissue

18. PATHOLOGICAL CHANGES
• Grossly-
• The thyroid is moderately, diffusely and symmetrically
enlarged
• Weight upto 70-90 gm
•Histologically-
•Considerable epithelial hyperplasia and hypertrophy
•The colloid is markedly diminished and is lightly staning

19. CLINICAL FEARTURES
• Slowly and insidiously
• Ophthalmopathy and dermatopathy
• Ocular abnormalities

20. REFERENCES
• Bartram T. Encyclopedia of Herbal Medicine.
Dorset, England: Grace Publishers; 1995:422
• Text book of pathology
• (Harsh Mohan), 5th edition

21. THANK YOU…