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HYPERTHYROIDISM 


"Hyperthyroidism" refers to hormone secretion over required amount for tissues and overwork of thyroid gland. If thyroid produces excess hormone, this time pituitary reduces TSH production and TSH measurement examined in blood shows the values below normal limits. Thyroid hormones reaching tissues in amounts more than normal values cause increase in all function in the body. "Thyrotoxicosis" refers to a state in which hyperthyroidism develops depending on non-thyroid causes or emerged with thyroid follicular destruction. 

Causes of hyperthyroidism
1 – Over stimulation of thyroid
Basedow-Graves' disease 
Over HCG 
Pituitary tumors 
Over iodine uptake 

2- Hyperthyroidism causes depending on thyroid nodules
Toxic autonomous functional thyroid nodule 
Toxic multinodular goiter 

3- Hyperthyroidism developed depending on thyroid damage 
Subacute thyroiditis 
Postpartum thyroiditis 
Painless or silent thyroiditis 
Thyroiditis developed depending on radiation 
Acute suppurative thyroiditis 

4- Hyperthyroidism developed depending on various reasons
Excessive intake of T3 and T4 hormones 
Struma ovarii 

Symptoms and Findings
In patients with hyperthyroidism, findings such as psychological changes such as irritability, emotional instability, aggression, anxiety and sometimes delusions, insomnia, increased sweating, intolerance to heat, flushing (vasodilatation consisting of increased thyroid hormones in circulation), thinning and loss of skin and hair, softening nails, pretibial myxedema, thirst, fatigue, neuromuscular disorders such as weakness in shoulder muscles and difficulty in climbing stairs, (the most common neuromuscular symptoms are tremor, and proximal neuropathy), despite increased appetite, weight loss, weight loss, resting tachycardia, palpitations, atrial fibrillation (hyperthyroidism is in 3rd number with approximately 5-15 %  among primary atrial fibrillation), symptoms such as dyspnea, leg swelling, diarrhea, steatorrhea, vomiting and anorexia and goiter, tremor, eye symptoms, splenomegaly, gynecomastia, palmar erythema, and hypercalcemia depending on increase of bone metabolism are available.


Hyperthyroidism İn Pregnancy 
Diagnosis of hyperthyroidism in pregnancy can be difficult since symptoms may be confused with symptoms of pregnancy. Upper limit of TT4 in pregnancy should be taken as 1.5 times the normal value. Note that TSH lower value in the first 3 months of normal pregnancy is an expected finding.  Propylthiouracil (PTU) in small doses is preferred in treatment. Purpose here is to keep patient in slight hyperthyroid condition.