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What is the most common cause of Hyperthyroidism?
Graves' disease (diffuse toxic goiter)
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Describe the pathology of Graves' disease.
An autoimmune disorder: A thyroid-stimulating immunoglobulin (Ig) G anti-body binds to the TSH receptors on the surface of thyroid cells and triggers the synthesis of excess thyroid hormone.
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What would a radioiodide scan of a patient with Graves' disease show?
Diffuse uptake because every thyroid cell is hyper-functioning.
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Describe the pathology of Plummer's disease.
It is a multinodular toxic goiter: characterized by hyper-functioning areas that produce high T4 and T3 levels, thereby decreasing TSH levels. As a result, the rest of the thyroid is not functioning (atrophy due to increased TSH).
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What would a thyroid scan of a patient with Plummer's disease show?
Patchy uptake because only certain cells are hyper-functioning and producing high T3 and T4 levels which decrease TSH levels. So, the rest of the thyroid fails to function and starts to atrophy.
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Plummer's disease is more common in which patient population?
The elderly.
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Which conditions can cause transient hyperthyroidism?
Hashimoto's Thyroiditis and subacute (granulomatous) thyroiditis, also postpartum thyroiditis
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Describe the presentation of a thyroid gland in a patient with Graves' disease.
A diffusely enlarged (symmetric), non-tender thyroid gland; a bruit may be present
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Describe the presentation of a thyroid gland in a patient with subacute thyroiditis.
An exquisitely tender, diffusely enlarged gland (with a viral illness)
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Describe the presentation of the thyroid gland in Plummer's disease and Hashimoto's Thyroiditis.
(if multi-nodularity is present) thyroid gland is bumpy, irregular and asymmetric
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Describe the presentation of a toxic adenoma.
single nodule with an otherwise atrophic gland
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What causes proptosis in Grave's disease?
edema of the extraocular muscles and retro-orbital tissue
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What skin changes are seen in hyperthyroidism?
Warm and moist, pretibial myxedema (edema over tibial surface due to dermal accumulation of mucopolysaccharides)
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What is the initial test of choice for Hyperthyroidism?
Serum TSH level (low): if the TSH is normal or high, hyperthyroidism is unlikely (TSH-induced hyperthyroidism is quite uncommon).
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