Signs and Symptoms of Hyperthyroidism
Hyperthyroidism is characterized by tremors, nervousness, insomnia, excessive sweating, heat intolerance, tachycardia, hypertension, and goiter, which can lead to serious complications if left untreated. 1, 2
Common Systemic Symptoms
- Cardiovascular manifestations: Tachycardia, hypertension, palpitations, decreased systemic vascular resistance, increased cardiac output, and potential pulmonary artery hypertension 1
- Neurological symptoms: Tremors, nervousness, anxiety, hyperactivity, and insomnia 1, 2
- Dermatological symptoms: Excessive sweating, heat intolerance, and hair loss 1, 2
- Gastrointestinal symptoms: Diarrhea and unintentional weight loss 3
Specific Clinical Findings
- Goiter: Diffuse enlargement of the thyroid gland, particularly common in Graves' disease 4, 3
- Ophthalmologic signs: Eyelid lag or retraction, exophthalmos (bulging eyes), and stare, particularly in Graves' disease 4, 3
- Dermatologic signs: Localized and pretibial myxedema (in Graves' disease) 4
Severe Manifestations
- Thyroid storm: A rare but life-threatening emergency characterized by severe acute exacerbation of hyperthyroidism symptoms, requiring immediate medical attention 4, 2
- Cardiac complications: Heart failure in severe, long-standing cases, particularly with persistent tachycardia or rapid atrial fibrillation 1
- Pregnancy complications: Increased risk of severe preeclampsia, preterm delivery, heart failure, and possibly miscarriage in pregnant women 4, 2
Important Clinical Considerations
- Symptoms can vary in intensity depending on the severity of hyperthyroidism, patient age, and duration of disease 3
- Elderly patients may present with subtle or atypical symptoms, sometimes referred to as "apathetic hyperthyroidism," with predominant cardiovascular manifestations 3
- Subclinical hyperthyroidism (low TSH with normal T3/T4) may present with milder symptoms or be asymptomatic 3
Diagnostic Approach
- Diagnosis is generally based on clinical symptoms plus laboratory findings showing elevated free thyroxine (FT4) level or free thyroxine index (FTI) with suppression of thyroid-stimulating hormone (TSH) 4
- In Graves' disease (responsible for 95% of hyperthyroidism cases in pregnancy), the presence of TSH receptor antibodies confirms the diagnosis 4, 5
Complications of Untreated Hyperthyroidism
- Cardiac arrhythmias, particularly atrial fibrillation 2, 3
- Osteoporosis due to accelerated bone turnover 3
- Adverse pregnancy outcomes 2
- Increased mortality risk 3
Remember that prompt recognition of these signs and symptoms is crucial for early diagnosis and treatment to prevent serious complications of hyperthyroidism.