HYPERTHYROIDISM &

THYROTOXICOSIS
 DEFINATIONS
• HYPERTHYROIDISM.
• Condition due to increased synthesis of
thyroid harmones. T3 & T4.

• THYROTOXICOSIS. Clinical manifestation of

hyperthyroidism is called thyrotoxicosis.
• Primary .
• Secondary.
CLINICAL FEATURES.
CAUSES OF THYROTOXICOSIS
Management of thyrotoxicosis.
 CLINICAL TYPES.
• DIFFUSE TOXIC GOITRE.. (GRAVES DISEASE).
• TOXIC NODULAR GOITRE,(PLUMMER”S DISEASE).
• TOXIC NODULE.
• HYPERTHYROIDISM DUE TO OTHER CAUSES.

• 50% of patients have family h\o autoimmune

endocrine disease.
• Hypertrophy of the whole gland due to TSHrAb
binds to TSH receptor site.
• Features of hyperthyroidism in a preexisting
nodular goitre.
• Solitary overactive nodule which may be
part of generalized nodularity or true toxic
adenoma it is autonomous .
• TSH secretion is suppressed.
 PRINCIPLES OF TREATMENT.
• ANTITHYROID DRUGS.
• SURGERY.
• RADIOIODINE.

• Carbimazole , PTU.
• Failure rate is 50%.
• Milder cases for 6 months,
• Severe cases for 2 years.
• Surgery is indicated in toxic nodular goitre
and toxic autonomous nodule.
• Overactive internodular tissue is decreased.
• Chances of recurrance after subtotal
thyroidectomy.
• Radioiodine destroys thyroid cells.
• Contraindicated in pregnancy , children.
• Severe eye symptoms.
 CHOICE OF THERAPY.
• DIFFUSE TOXIC GOITRE.
• Antithyroid drugs.
• Radio iodine.
• TOXIC NODULAR GOITRE.
• Anti thyroid drugs.
• Surgery.
• TOXIC NODULE.
• Surgery.
• Radio iodine over 45 years.
• FAILURE OF TREATMENT.
• Surgery.
• Thyroid ablation with radioactive Iodine.
 PREOPERATIVE PREPARATION.
• Out patient basis.
• Carbimazole 30-40 mg for 8-12 months when
euthyroid 5mg 8 hrly.
• Block and replace therapy..
• .1-0.15mg of thyroxine is given along with carbimazole.
• B blockers propranolol 40mg TDS. Or Nodolol 160mg
OD. Olso postop for 7 days.
• Iodine can be given with Bblockers and carbimazole 10
days preop.
• Produce transient remission, reduces vascularity.
SURGICAL MANAGEMENT.
 SURGICAL PROCEDURES.
• PARTIAL THYROIDECTOMY.
• SUBTOTAL THYROIDECTOMY.
• NEAR TOTAL THYROIDECTOMY.
• TOTAL THYROIDECTOMY.
MULTINODULAR GOITRE DIFFUSE GOITRE
EYE SIGNS
1. Lid Lag
2. Lid Retraction
3. Opthalmoplegia
4. Orbital proptosis
THANK YOU