Hyperthyroidism Diagnosis, Treatment and Patient education
Medical history and physical examination: –
During the test your primary care physician may attempt to identify mellow tremors in your fingers when they are augmented, hyperactive reflexes, eye changes, and warm, sodden skin.
Your doctor will also examine your thyroid gland, as you swallow, to see if it is large, boring, or tender, and check your pulse to see if it is sharp or irregular.
Image source: Hyperthyroidism Physical examination
Radioiodine take-up test: –
For this test, you take a little, oral portion of radioactive iodine (radioiodine) to see how much will accumulate in your thyroid gland.
You will be tested after four, six or 24 hours – and sometimes after all three time periods – to see how much iodine is absorbed by your thyroid.
Blood tests that measure thyroxine and thyroid-invigorating hormone (TSH) can affirm the finding. High levels of thyroxine and little or none of TSH indicate a hyperactive thyroid.
The amount of TSH is important because it is the hormone that signals your thyroid gland to produce more thyroxine.
These tests are especially necessary for older adults who may not have classic symptoms of hyperthyroidism.
Thyroid Ultrasound: –
This test utilizes high recurrence sound waves to deliver pictures of the thyroid.
Ultrasound may be better at detecting thyroid nodules than other tests, and is not exposed to any radiation.
Thyroid scan: –
During this test, you will be injected radioactive isotopes inside your elbow or sometimes in the vein of your hand. You then lie down on a table with your head extended backwards, while a special camera images your thyroid gland on the computer screen.
This test indicates how iodine gathers in your thyroid.
Treatment goal: –
Symptomatic relief is provided until definitive treatment can be effected.
Therapeutic Agent: –
Anti-thyroid agent (thiomide)
These agents can help achieve relaxation through direct interference with thyroid hormone synthesis. Both agents inhibit iodide oxidation and iodothoresyl coupling. In addition, decreases peripheral dissolution of T4 to T3.
Therapeutic uses of these drugs include
Fixed treatment in which remission is obtained
Adjuvant therapy with radioactive iodine until radiation is effective
Pre-preparation to establish and maintain thyroid status until definitive surgery can be performed.
For adults, the initial dose is 300 to 450 mg / day in three divided doses (ie, 100 to 150 mg every 8 hours). Adult patients with critical illness may initially require 600 to 900 mg / day.
The initial dose continues for about 2 months; A maintenance dose of 100 to 150 mg / day is then given, as a single dose or divided into two doses.
Maintenance therapy continues for about 1 year, and then is gradually discontinued for 1 to 2 months, while the patient is monitored for signs of recurrent hyperthyroidism.
The patient may remain in remission for several years. A recurrent episode of hyperthyroidism is likely to occur within 3 to 6 months of drug withdrawal.
Methymazole (Tapazole, MMI): –
The initial dose range is 15 to 60 mg / day in three divided doses depending on the severity of the disease. After 2 months of therapy, a maintenance dose of 5 to 30 mg / day is started.
Maintenance therapy continues for about 1 year, at which time the medication is gradually discontinued, typically 1 to 2 months.
Precautions and monitoring effect: –
Serum thyroid levels and FTI should be monitored for a return to normalcy. An elevated T3 may indicate inadequate treatment, whereas an elevated TSH may indicate excessive anti-thyroid treatment.
The size of the should be reduced with low hormone production.
Radioactive Iodine (RAI): –
The thyroid gland selects the radioactive element iodine-133 because it is regular iodine. Radioactivity subsequently destroys some cells that would otherwise concentrate iodine and produce T4, reducing the production of thyroid hormones.
The oral dose is 4-10 mcg administered orally. Toxic nodular goiter and other special conditions will require the use of larger doses.
Precautions and monitoring effect: –
Radioiodine is not commonly used in patients under 30, especially in women because the effect on spring is not known in the future.
This response is difficult to respond to, and patients should be monitored quickly for recurrence of hyperthyroidism, and later for hypothyroidism, which may develop 20 years or more even after therapy.
β-adrenergic blocking agent: –
Propranolol (Inderal) is usually applied 20 to 40 mg four times daily, which reduces thyrotoxic manifestations (e.g. tachycardia, sweating, severe tremors, and nervousness).
In addition to providing symptomatic relief, propranolol’s at high doses (> 160 mg / day) inhibit peripheral conversion of T4 to T3.
β-blockers are the primary adjuvant therapy for RAI.
Patients Counseling on anti-thyroid drugs: –
Identify the expected duration of treatment.
Explain blocks and replacements.
For example, explain the use of adjuvant therapy.
Encourage reporting of skin rashes, sore throat or mouth ulcers.
Ensure that the patient understands the need for regular review.
Outline Management of Residues.
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