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 Thyroid hyperactivity mimics epinephrine excessRaised pulse and anxietyHypertension with tachycardiaEyelid lag/retractionTremorDislike of heatIrritability

 Cardiac disturbances are often present, particularly in older patients, and include tachycardia, arrhythmias (especially atrial fibrillation) and cardiac failure

 Additional features:Exophthalmos or proptosisThyroid swelling/lump (goitre)Warm, moist and erythematous skinFine brittle hairChange in weight – typically loss of weight although an increased appetite can lead to weight gainDiarrhoea

 Thyrotoxic periodic paralysis (attacks of mild to severe weakness)

 Thyrotoxic crisis/thyroid stormA severe condition that starts with extreme anxiety, nausea, vomiting and abdominal painLater, it is associated with fever, sweating, tachycardia and pulmonary oedemaFinally, stupor, coma and possibly deathTable 5.3.2 Causes of hyperthyroidism.CategoryCausesPrimaryIncreased stimulation secondary to:Thyroid‐stimulating hormone receptor antibodies (TRAb), seen mostly in Graves diseaseExcess human chorionic gonadotropin (hCG) secretion in patients with hyperemesis gravidarumTrophoblastic tumours such as choriocarcinoma or hydatidiform moleAutonomous thyroid functionToxic multinodular goitreSolitary toxic noduleFamilial non‐autoimmune hyperthyroidismExcess release of stored thyroid hormoneAutoimmune (silent or postpartum thyroiditis)Infective (viral, bacterial, fungal)Pharmacological (amiodarone, interferon‐alpha)Exposure to excess iodineExcess iodine intake during radiographic contrastConsumption of high quantities of iodine‐rich foods (e.g. fish, seaweed, egg yolks)/supplements/medications containing iodine (amiodarone)SecondaryInappropriate thyroid‐stimulating hormone (TSH) secretionTSH‐secreting pituitary adenomaPituitary resistant to thyroid hormoneExtrathyroidExcess intake of thyroid hormoneIatrogenic/factitiousEctopic thyroid hormone secretionStruma ovariiFunctional thyroid metastases