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Related Concept Videos

Hyperthyroidism I: Introduction01:25

Hyperthyroidism I: Introduction

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Hyperthyroidism is a type of thyrotoxicosis characterized by the thyroid gland's overproduction of the thyroid hormones triiodothyronine (T3) and thyroxine (T4). This hormone excess increases the basal metabolic rate and enhances sensitivity to catecholamines.DiagnosisDiagnosis is based on clinical features and biochemical testing. It typically shows suppressed thyroid-stimulating hormone (TSH) levels below 0.4 mIU/L, with elevated free T3 and/or T4. Additional tests, including thyroid...
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Hyperthyroidism II: Pathophysiology01:27

Hyperthyroidism II: Pathophysiology

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Hyperthyroidism is a hypermetabolic state caused by elevated levels of thyroid hormones, triiodothyronine (T3) and thyroxine (T4). It results from dysregulation at the thyroid, pituitary, or immune system level and affects multiple organ systems.PathophysiologyThe most common cause of hyperthyroidism is Graves’ disease, an autoimmune disorder in which antibodies, specifically thyroid-stimulating antibodies (TSAb), a subtype of TSH receptor antibodies (TRAb), bind to and activate TSH...
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Hypothyroidism II: Pathophysiology01:23

Hypothyroidism II: Pathophysiology

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Hypothyroidism is a disorder characterized by insufficient production of thyroid hormones, which regulate metabolism, energy balance, and multiple organ systems.TypesHypothyroidism is classified based on the level of dysfunction. Primary hypothyroidism results from intrinsic thyroid gland dysfunction, causing reduced hormone production despite normal or increased stimulation. Secondary hypothyroidism arises from inadequate thyroid-stimulating hormone (TSH) secretion by the pituitary. Tertiary...
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Graves Disease II: Pathophysiology01:24

Graves Disease II: Pathophysiology

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Graves’ disease is an autoimmune disorder characterized by the production of thyroid-stimulating immunoglobulins (TSI) that activate TSH receptors, leading to excessive synthesis and release of thyroid hormones (T3 and T4) and resulting in hyperthyroidism.Among all causes of hyperthyroidism, Graves’ disease is the most common and can happen at any age, though it is more frequent in women. It produces a hypermetabolic state with features such as weight loss, tachycardia, tremor,...
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Graves' Disease I: Introduction01:28

Graves' Disease I: Introduction

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Graves' disease is an autoimmune disorder that causes hyperthyroidism, or overactivity of the thyroid gland. It results from autoantibodies called thyroid-stimulating immunoglobulins (TSIs), which bind to thyroid-stimulating hormone (TSH) receptors, leading to overstimulation of hormone production and a hypermetabolic state.EtiologyAlthough considered idiopathic, Graves’ disease has well-established contributing factors. There is a strong genetic component, with increased prevalence...
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Synthesis and Regulation of Thyroid Hormones01:20

Synthesis and Regulation of Thyroid Hormones

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Low blood levels of the thyroid hormones — triiodothyronine (T3) and thyroxine (T4) — signal the hypothalamus to release the thyrotropin-releasing hormone (TRH). TRH then reaches the pituitary gland and stimulates the release of thyroid-stimulating hormone(TSH) into the bloodstream.
Upon reaching the thyroid gland, TSH stimulates the follicular cells' active uptake of iodide ions from the blood. The ions diffuse to the apical surface of the cells and are oxidized to iodine. The...
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Author Spotlight: Integrating Ultrasound Imaging with Biochemical Markers for Thyroid Disease Diagnosis
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Oscillating hypothyroidism and hyperthyroidism - a case-based review.

WuQiang Fan1, Prabhat Tandon1, Mahesh Krishnamurthy2

  • 1Internal Medicine Residency, Department of Medicine, Easton Hospital, Drexel University College of Medicine, Easton, PA, USA.

Journal of Community Hospital Internal Medicine Perspectives
|November 30, 2014
PubMed
Summary

Autoimmune thyroid disease can cause alternating hypothyroidism and hyperthyroidism due to fluctuating thyroid autoantibodies. Vigilance and antibody testing are key for diagnosing this rare condition.

Keywords:
TBAbTSAbhyperthyroidismhypothyroidismoscillating

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Area of Science:

  • Endocrinology
  • Immunology
  • Internal Medicine

Background:

  • Autoimmune thyroid disease (AITD) encompasses conditions like Hashimoto's thyroiditis and Graves' disease.
  • Thyroid autoantibodies, including TSH-blocking autoantibodies (TBAb) and thyroid-stimulating autoantibodies (TSAb), play a critical role in AITD pathogenesis.
  • Fluctuations in these autoantibodies can lead to dynamic shifts in thyroid function.

Observation:

  • A 52-year-old female with a history of hypothyroidism presented with alternating symptoms of hyperthyroidism and hypothyroidism.
  • Her thyroid function tests showed paradoxical swings, with suppressed TSH during hyperthyroid phases and elevated TSH during hypothyroid phases.
  • Treatment with methimazole and levothyroxine appeared to influence the autoantibody activity, exacerbating the cyclical nature of her thyroid status.

Findings:

  • The patient experienced at least two cycles of spontaneous conversion between hyperthyroidism and hypothyroidism.
  • Swinging dominance of TBAb and TSAb, potentially triggered by medications like methimazole and levothyroxine, was identified as the likely underlying mechanism.
  • Radioactive iodine ablation followed by levothyroxine replacement ultimately stabilized her thyroid function.

Implications:

  • Physicians must maintain a high index of suspicion for fluctuating thyroid function in patients with AITD.
  • Repeated assessment of thyroid function tests and measurement of specific thyroid autoantibodies (TBAb and TSAb) are crucial for diagnosing this rare clinical entity.
  • Understanding the interplay between autoantibodies and medications is vital for managing patients with dynamic thyroid dysfunction.