Hyperthyroidism (thyrotoxicosis)

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  1. In critically ill patients, symptoms of hyperthyroidism are different than in the ambulating population
    1. symptoms in the ICU include arrhythmias, persistent tachycardia, high output cardiac failure, diarrhea, excessive CO2 production, and fever
    2. patients have elevated T4 and T3 with low concentrations of TSH
      1. free T4 is usually more reliably elevated because of its insensitivity to binding protein changes
      2. T3 may not be elevated in critically ill patients because of a decreased conversion of T4 to T3
  2. Thyrotoxicosis- caused by Grave's disease, disseminated autonomy (DISA), toxic nodules and thyroid autonomy, subacute thyroiditis
    1. Thyroid storm typically occurs 6 to 8 hours after surgery
  3. encephalopathy has been reported but is rare
  4. progressive weakness and wasting of skeletal muscle is common in hyperthyroidism (50% are of thyrotoxic patients are myelopathic); muscles of the pelvic girdle and thighs are weakened more than others; tremor and twitching will also occur with increased tendon reflexes
    1. there is also an association between myasthenia gravis and hyperthyroidism in that patients with hyperthyroidism are 20-30 times more likely to get myasthenia gravis
    2. extraocular muscles of the inferior and medial rectus are commonly involved
  5. treatment: decrease production of thyroid hormone and peripheral conversion of T4 to T3; for thyroid storm usually need lots of fluids betablockers, and methimazole that block synthesis of thyroid hormone; or propylthiouracil that blocks peripheral conversion of T4 to T3
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