Recognize the physical exam findings of hyperthyroidism!
Skin: warm moist skin, pretibial myxedema(Graves disease), thyroid acropachy, clubbing (Graves)
Eyes: Lid lag, stare, Proptosis (Graves disease), extra-ocular impairment (Graves disease)
CV: arrhythmias (sinus tachycardia, atrial fibrillation), high output CHF
Neuro: fine tremor, hyperreflexia
Psych: anxiety, agitation, psychosis, depression, insomnia, mania
Thyroid: diffuse thyromegaly, thyroid bruit (specific for Graves)
High radioactive iodine uptake on RAIU scan in hyperthyroidism (de novo synthesis of thyroid hormone)
1)Graves disease-can also diagnose with TSI-high sensitivity/specificity
3)Multinodular Toxic Goiter
4)Iodine deficiency (rare in the USA)
Low radioactive iodine uptake on RAIU scan in hyperthyroidism (inflammation and destruction of thyroid tissue with release of pre-formed hormone OR extra-thyroidal source of thyroid hormone)
1)Thyroiditis (subacute granulomatous thyroiditis (De Quervains), painless, post-partum, suppurative/infectious thyroiditis)
2)Exogenous thyroid hormone administration
4)Drug induced (eg: Amiodarone)
5)IV contrast load
-Methimazole and beta blockers (eg:Propranolol) for hyper-adrenergic symptoms
-AVOID radio-iodine ablation if Graves’ ophthalmopathy, as can worsen eye involvement but
-Monitor for risk of agranulocytosis and hepatotoxicity with Methimazole!
See picture below for symptoms of hyperthyroidism! (copyright Nursing Education Consultants Inc) *Note that hyperdefecation commonly occurs, not diarrhea.