Thyrotoxicosis
Thyrotoxicosis results from excess thyroid hormone due to either excess production (hyperthyroidism) or release of preformed thyroid hormone from the gland (thyroiditis). The prevalence of thyrotoxicosis is 1–2% in women and 0.1–0.2% in men. Graves’ disease, which is caused by activating thyrotropin receptor antibodies, is the most common cause of hyperthyroidism. Nodular thyroid disease is the second most common cause with multinodular goiter being more common than toxic adenoma. Thyroiditis is caused by inflammation of the thyroid gland from various etiologies that results in the release of stored thyroid hormone. Classic symptoms of thyrotoxicosis include palpitations, tremor, diaphoresis, restlessness, insomnia, anxiety, heat intolerance, weight loss, and hyperdefecation. Graves’ orbitopathy may also be present in 25–70% of patients with Graves’ disease. Treatment of Graves’ disease and nodular thyroid disease focuses on reducing the symptoms of hyperthyroidism with beta-blockade and decreasing further production of thyroid hormone. The latter can be done with antithyroid drugs (methimazole, propylthiouracil) and/or definitive therapy with radioactive iodine or surgery. On the other hand, treatment of thyroiditis focuses on symptomatic management with beta-blockers and does not require antithyroid drugs. Long-term prognosis is generally favorable if the condition is recognized and treated appropriately.
