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Problems in Thyroid Disease

Thyroid disease is a common disorder that as affects 5-10 % of the adult U.S. population. Subclinical hypothyroidism is the most common disorder.

Graves' Disease

This is the most common cause of thyrotoxicosis in all age groups. Autoantibodies directed at the TSH receptor stimulate both thyroid hormone synthesis and thyroid growth. Patients present with signs and symptoms of thyrotoxicosis - fatigue, weight loss, tachycardia, atrial arrhythmias, hyperdefecation, sweats, and tremor - associated with a goiter, eye changes, and rarely dermopathy. Graves' disease always presents with either a goiter or some evidence of eye involvement.

There are three options in treatment: antithyroid drugs (ATD), radioactive iodine (RAI), and surgery. ATD are first line therapy for most patients since Graves disease most commonly presents in younger women. ATD are safe but agranulocytosis and hepatitis may rarely occur. Both appear to be dose related and reverse upon discontinuing the drug. Long-term remissions in the U.S. are low with ATD perhaps due to dietary or genetic influences. RAI (5-25 mci PO) is a safe and effective alternative to ATD for the treatment of Graves' disease when ATD fail.

Graves' ophthalmopathy will not be altered, and could be worsened, by treatment for their Graves' disease. Treatment with RAI.

Hypothyroidism and Thyroid Hormone Replacement

The most common cause of hypothyroidism is Hashimoto's thyroiditis, a chronic autoimmune destruction of the thyroid. In its overt form, hypothyroidism is easy to recognize. Patients present with cold intolerance, mental slowing, peripheral edema (pitting and non-pitting), and weight gain. In its subclinical form, however, this disorder is much more difficult to recognize. Measurement of serum TSH is essential to make the later diagnosis. These patient have TSH values above the normal.