Features of hypehyroidism are all except: March 2007
Ans. B: Cold intolerance Causes Functional thyroid tissue producing an excess of thyroid hormone occurs in a number of clinical conditions. The major causes are: - Graves' disease (the most common etiology with 70-80%) - Toxic thyroid adenoma - Toxic multinodular goitre High blood levels of thyroid hormones/hypehyroxinemia can occur for a number of other reasons: - Inflammation of the thyroid is called thyroiditis. There are a number of different kind of thyroiditis including Hashimoto's (immune mediated), subacute (inflammatory), and DeQuervain's (granulomatous). These may be initially associated with secretion of excess thyroid hormone, but usually progress to gland dysfunction and thus, to hormone deficiency and hypothyroidism. - Struma ovarii (a teratoma of the ovary) can produce excess thyroid hormone. - Amiodarone, a hea medication, can sometimes cause hypehyroidism. - Postpaum thyroiditis (PPT) occurs in about 7% of women. Major clinical signs include weight loss (often accompanied by a increased appetite), anxiety, intolerance to heat, fatigue, hair loss, weakness, hyperactivity, irritability, apathy, depression, polyuria, polydipsia, and sweating. Additionally, patients may present with a variety of symptoms such as palpitations and arrhythmias (notably atrial fibrillation), shoness of breath (dyspnea), loss of libido, nausea, vomiting, and diarrhea. Long term untreated hypehyroidism can lead to osteoporosis Neurological manifestations can include tremor, chorea, myopathy, and in some susceptible individuals (paicularly of asian descent) periodic paralysis. Minor ocular (eye) signs, which may be present in any type of hypehyroidism, are eyelid retraction ("stare") and lid-lag. In hypehyroid stare (Dalrymple sign) the eyelids are retracted upward more than normal (the normal position is at the superior corneoscleral limbus, where the "white" of the eye begins at the upper border of the iris). In lid-lag (von Graefe's sign), when the patient tracks an object downward with their eyes, the eyelid fails to follow the downward moving iris, and the same type of upper globe exposure which is seen with lid retraction occurs, temporarily. These signs disappear with treatment of the hypehyroidism. Neither of these ocular signs should be confused with exophthalmos (protrusion of the eyeball) which occurs specifically and uniquely in Graves' disease. This forward protrusion of the eyes is due to immune mediated inflammation in the retroorbital (eye socket) fat. Measuring the level of thyroid-stimulating hormone (TSH) in the blood is usually all that is required. A low TSH indicates that the pituitary gland is being inhibited by increased levels of T4 and/or T3 in the blood, and is therefore a reliable marker of hypehyroidism. Measuring specific antibodies, such as anti-TSH-receptor antibodies in Graves' disease, or anti-thyroid-peroxidase in Hashimoto's thyroiditis, may also contribute to the diagnosis. Thyroid scintigraphy is a useful test to distinguish between causes of hypehyroidism, and this entity from thyroiditis.
Voracious appetite
Cold intolerance
Emotional disturbance
Sleeplessness