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Thyrotoxicosis associated with hyperthyroidism Aetiologies (common) Mechanism Graves’ disease Thyrotropin receptor antibodies stimulate the thyroid-stimulating hormone (TSH) receptor Toxic multinodular goitre Activating mutations in TSH receptor or G proteins Solitary toxic adenoma Functional autonomy within a benign lesion Aetiologies (uncommon) Mechanism TSH secreting pituitary adenoma Pituitary adenoma Pituitary resistance to thyroid hormone Mutation of thyroid hormone receptor β Neonatal Graves’ disease Thyroid stimulating immunoglobulins Choriocarcinoma Human chorionic gonadotropin Hyperemesis gravidarum Human chorionic gonadotropin Congenital hyperthyroidism Activating mutations in TSH receptor Struma ovarii Toxic adenoma within dermoid tumour of the ovary Metastatic follicular thyroid carcinoma Foci of functional autonomy Iodine or iodine containing drugs Jod-Basedow phenomenon; excess iodine results in unregulated thyroid hormone production Thyrotoxicosis not associated with hyperthyroidism Aetiologies (common) Mechanism Thyroiditis Painless including postpartum Autoimmune, release of stored thyroid hormones Sub-acute thyroiditis Viral infection, release of stored thyroid hormones Exogenous thyroid hormone Iatrogenic or factitious excess ingestion of thyroid hormone Aetiologies (uncommon) Mechanism Drug induced thyroiditis Destruction of thyroid follicles Acute infectious thyroiditis Bacterial or fungal thyroid infection Radiation induced thyroiditis Radioactive iodine induced thyrocyte destruction Thyroid adenoma infarction Release of stored hormones Symptoms Signs Cardiovascular Palpitations, shortness of breath Tachycardia, hypertension, atrial arrythmia, high output cardiac failure Gastrointestinal Increased appetite Weight loss Central nervous system Emotional lability, poor concentration, agitation Hyperactivity, agitation Eyes (usually in Graves’ disease) Soreness, grittiness Periorbital oedema, lid retraction and lid lag, conjunctival injection, ophthalmoplegia Thyroid Neck swelling Goitre Muscles Weakness, tremor Tremor, muscle wasting Skin Sweating, heat intolerance Increased sweating Hair Hair thinning Hair loss Peripheral nervous system Hyperreflexia Reproductive system Oligomenorrhoea. Reduced fertility (women)
