Regulation of thyroid hormones. Normal: around 20 gm (Contrast: can be as much as 200 gm in Graves) TSH goes down before you see an increase in T3, T4. (Lancet Subclinical disease graph) 80 micro of T4 / day. 5 microgram/day : Normal production Bound to THBG (70%) Pre-albumin (15%) aka Transthyretin Albumin (15%) Only 1 % is active form. Hyperthryoid 95 % of time, no role of T3. Only about 5 % of hyperthyroid are T3 hyperthyroid. T1/2 of 1 week. Hence, no urgency of giving thyroid hormone after surgery unlike adrenectomy. After adrenectomy Hormone replacement has to be quick. Antibody. TSI, TPO, Thyroglobulin ab. Clinical Manifestation of Hyperthyroidism: Overt, Subclinical, Apathetic, Storm (or impending storm) PTU: Only first trimester of pregnancy Toxic Hot nodule : RAI treatment ? higher dose than for graves disease? Increased uptake HCG mediated Prior to surgery: Iodine can be given as it decreases the vascularity Graves: No longer total thyroidectomy is done. We do partial thyroidectomy. Recurrent Laryngeal Nerve damage. Short, non-mobile, bowed. Superior laryngeal nerve damage. More difficult to diagnose. HYPERTHYROIDISM: 2/2 Etiology: TSH Goal: Controlled / Uncontrolled Radioiodine Therapy for Hyperthyroidism NEJM 2011M: Antithyroid Drugs NEJM 2005 Additional Reading Diagnosis and management of thyrotoxicosis BMJ 2014 Thyrotoxicosis Lancet 2012 Endocrine and metabolic emergencies: thyroid storm There Adv Endocrinol Metab (2010) Thyroiditis NEJM 2003 Thyroiditis AAFP 2006 Graves Disease Clinical Manifestation DDx of Hyperthyroidism Evaluation and Monitoring of Graves Disease ![]() ![]() Additional References: Thyroid Storm Appreciate how hCG causes Hyperthyroidism, and Gynecomastia |