Sandbox: hyperthyroidism 2: Difference between revisions

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|-
|-
|Generalized anxiety disorder
|Generalized anxiety disorder
|DSM-V Diagnostic Criteria for Generalized Anxiety Disorder{{cquote|
|According to DSM V, the following criteria should be present to fit the diagnosis of generalized anxiety disorder:
*A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school
performance).


'''''AND'''''
*The presence of sense of apprehension or fear toward certain activities for most of the days for at least 6 months
*Difficulty to control the apprehension
*Associated restless, fatigue, irritability, difficult concentration, muscle tension or sleep disturbance (only one of these manifestations)
*The anxiety or the physical manifestations must affect the social and the daily life of the patient
*Exclusion of another medical condition or the effect of another administered substance
*Exclusion of another mental disorder causing the symptoms


*B. The individual finds it difficult to control the worry.
'''''AND'''''
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the
past 6 months);
<SMALL>''Note: Only one item is required in children.''</SMALL>
:*1. Restlessness or feeling keyed up or on edge.
:*2. Being easily fatigued.
:*3. Difficulty concentrating or mind going blank.
:*4. Irritability.
:*5. Muscle tension.
:*6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
'''''AND'''''
*D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
'''''AND'''''
*E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g.,[[hyperthyroidism]]).
'''''AND'''''
*F. The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in [[panic disorder]], negative evaluation in social anxiety disorder [[social phobia]], contamination or other obsessions in [[obsessive-compulsive disorder]], separation from attachment figures in [[separation anxiety disorder]],
reminders of traumatic events in [[post traumatic stress disorder]], gaining weight in [[anorexia nervosa]], physical complaints in somatic symptom disorder, perceived appearance flaws in [[body dysmorphic disorder]], having a serious illness in illness anxiety disorder, or the content of delusional beliefs in [[schizophrenia]] or [[delusional disorder]]).
}}
}}
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|<nowiki>-</nowiki>
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|Menopausal symptoms
|Menopausal symptoms
|The perimenopause symptoms are caused by an overall drop, as well as dramatic but erratic fluctuations, in the levels of estrogens, progestin, and testosterone. Some of these symptoms such as formication etc may be associated with the hormone [[withdrawal]] process.
|The perimenopause symptoms are caused by an overall drop, as well as dramatic but erratic fluctuations, in the levels of estrogens, progestin, and testosterone. Some of these symptoms such as formication may be associated with the hormone [[withdrawal]] process.


'''Vasomotor instability'''
*Vasomotor instability in the form of [[Hot flashes]], [[hot flush]]es, including [[sleep hyperhidrosis|night sweats]] and [[Sleep disorder|Sleep disturbances]]
*[[Hot flashes]], [[hot flush]]es, including [[sleep hyperhidrosis|night sweats]]
*Urogenital atrophy causing [[Itch|Itching]], Dryness, [[Bleeding]], Watery discharge, [[Polyuria|Urinary frequency]], [[Urinary urgency]] and[[Urinary incontinence]]
*[[Sleep disorder|Sleep disturbances]]
*Skeletal symptoms in the form of [[Osteoporosis]] (gradually developing over time), [[Arthralgia|Joint pain]], [[myalgia|muscle pain]] and [[Back pain]]
'''Urogenital atrophy'''
*Psychological manifestations such as [[Mood disorder|Mood disturbance]], [[Irritability]], [[Fatigue (medical)|Fatigue]], [[Memory loss]] an[[Depression (mood)|Depression]]
*[[Itch|Itching]]
*Sexual disorders: [[Libido|Decreased libido]], [[Vaginal lubrication|Vaginal dryness]], Problems reaching orgasm and [[Dyspareunia]]
*Dryness
*[[Bleeding]]
*Watery discharge
*[[Polyuria|Urinary frequency]]
*[[Urinary urgency]]
*[[Urinary incontinence]]
'''Skeletal'''
*[[Osteoporosis]] gradually developing over time
*[[Arthralgia|Joint pain]], [[myalgia|muscle pain]]
*[[Back pain]]
'''Skin, soft tissue'''
*Breast atrophy
*Skin thinning
*Decreased elasticity
*[[Formication]], a sensation of pins and needles, or ants crawling on or under the skin
'''Psychological'''
*[[Mood disorder|Mood disturbance]]
*[[Irritability]]
*[[Fatigue (medical)|Fatigue]]
*[[Memory loss]]
*[[Depression (mood)|Depression]]
'''Sexual'''
*[[Libido|Decreased libido]]
*[[Vaginal lubrication|Vaginal dryness]]
*Problems reaching orgasm
*[[Dyspareunia]]
|
|
* [[Human chorionic gonadotropin|B-HCG]] should always be done first to rule out [[pregnancy]] especially in women under the age of 45 years
* [[Human chorionic gonadotropin|B-HCG]] should always be done first to rule out [[pregnancy]] especially in women under the age of 45 years

Revision as of 18:48, 14 August 2017


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

Differentiating hyperthyroidism from other diseases

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According to the origin of the abnormality
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Primary hyperthytoidism
 
 
 
 
Secondary hyperthyroidism
 
 
 
 
Tertiary hyoperthyroidism
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• Grave’s disease
• Toxic thyroid nodule
• Thyroid adenoma
• Multinodular goiter
 
 
 
 
• Pituitary adenoma
• Intracranial tumors pressing pituitary gland
 
 
 
 
• Excess thyroxin production due to disorders of the hypothalamus which may be due to intracranial tumors or masses.
 

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According to iodine uptake

Hyperthyroidism can be classified according to the results of iodine uptake test into[1]

High iodine uptake

High or normal uptake:

Low uptake:

 
 
 
 
 
 
 
 
According to Iodine uptake
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
High iodine uptake
 
 
 
 
High or normal uptake
 
 
 
 
Low uptake
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• Graves' disease
• Toxic multinodular goiter
• Toxic thyroid adenoma
 
 
 
 
• Iodine caused hyperthyroidism
• Hashitoxicosis
• Germ cell tumors (choriocarcinoma in males and testicular germ cell tumors)
• Pituitary TSH producing adenoma
 
 
 
 
• Subacute thyroiditis
• Hyperthyroidism due to ectopic thyroid tissue
• Factitious thyrotoxicosis
• Struma ovarii
• Painless thyroiditis
• Amiodarone induced thyroiditis-Type 1
• Amiodarone induced thyroiditis-Type 2
 
Disease Prominent clinical features Lab findings Images
Hyperthyroidism The main symptoms include:
  • The patient usually has elevated T3 and T4
  • TSH might be increased or decreased depending on the underlying cause
  • Thyroid stimulating antibodies (TSI) might be increased in cases of Graves’ disease
By Jonathan Trobe, M.D. - University of Michigan Kellogg Eye Center - The Eyes Have It, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=16115992
Essential hypertension Most patients with hypertension are asymptomatic at the time of diagnosis. Common symptoms are listed below: JNC 7 recommends the following routine laboratory tests before initiation of therapy for hypertension:
  • 12-Lead electrocardiogram (ECG)
  • Urinalysis, including urinary albumin excretion or albumin/creatinine ratio
  • Blood glucose
  • Blood hematocrit
  • Serum electrolytes, especially potassium
  • Serum calcium
  • Lipid profile: Total cholesterol, LDL, HDL, triglycerides
  • Creatinine or estimated GFR
 -
Generalized anxiety disorder According to DSM V, the following criteria should be present to fit the diagnosis of generalized anxiety disorder:
  • The presence of sense of apprehension or fear toward certain activities for most of the days for at least 6 months
  • Difficulty to control the apprehension
  • Associated restless, fatigue, irritability, difficult concentration, muscle tension or sleep disturbance (only one of these manifestations)
  • The anxiety or the physical manifestations must affect the social and the daily life of the patient
  • Exclusion of another medical condition or the effect of another administered substance
  • Exclusion of another mental disorder causing the symptoms

}}

- -
Menopausal symptoms The perimenopause symptoms are caused by an overall drop, as well as dramatic but erratic fluctuations, in the levels of estrogens, progestin, and testosterone. Some of these symptoms such as formication may be associated with the hormone withdrawal process.
  • B-HCG should always be done first to rule out pregnancy especially in women under the age of 45 years
  • FSH can be measured but it can be falsely normal or low
  • TSH, T3 and T4 to rule out thyroid abnormalities
  • Prolactin can be measured to rule out prolactinoma as a cause of menopause
 -
Opioid withdrawal disorder

DSM-V Diagnostic Criteria for Opioid Withdrawal

“
  • A. Presence of either of the following;
  • 1. Cessation of (or reduction in) opioid use that has been heavy and prolonged (i.e.,several weeks or longer).
  • 2. Administration of an opioid antagonist after a period of opioid use.

AND

  • B. Three (or more) of the following developing within minutes to several days after Criterion A:

AND

  • C. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

AND

  • D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.
 ”
  • Urine drug screen to rule out any other associated drug abuse
  • Routine blood work such as electrolytes and hemoglobin to rule out any associated disease explaining the symptoms
 -
Pheochromocytoma The hallmark symptoms of a pheochromocytoma are those of sympathetic nervous system hyperactivity, symptoms usually subside in less than one hour and they may include:
  • Palpitations especially in epinephrine producing tumors.
  • Anxiety often resembling that of a panic attack
  • Sweating
  • Headaches occur in 90 % of patients.
  • Paroxysmal attacks of hypertension but some patients have normal blood pressure.
  • It may be asymptomatic and discovered by incidence screening especially MEN patients.

Please note that not all patients with pheochromocytoma experience all classical symptoms.

Diagnostic lab findings associated with pheochromocytoma include:
Left sided pheocromocyroma - Case courtesy of Dr Bruno Di Muzio, Radiopaedia.org, rID: 44813
  1. ↑ [+http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)72981-0/abstract "Thyroid disease classification - The Lancet"] Check |url= value (help).
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