Goiter:  enlargement of the thyroid gland, causing a
swelling in the front part of the neck.

Hyperthyroidism: excessive
thyroid gland activity, marked by increased metabolic rate, goiter, and
disturbances in the autonomic nervous system and in creatine metabolism;
sometimes used to refer to Graves’ disease.

This metabolic imbalance results from Excessive thyroid Hormone. 
The most common form of hyperthyroidism is Graves’ disease, which increases
T 4 production, enlarges the thyroid gland (goiter), and causes multisystemic
changes.  An acute exacerbation of hyperthyroidism is called thyrotoxicosis,
is a medical emergency that may lead to cardiac failure.

Cause:  Believe to be an autoimmune disease.  Antibodies
to thyroglobulin or to thyroid microsomes occur in most patients with this


Enlarged thyroid


Heat intolerance

Weight loss (despite increased appetite)





Exophthalmos (abnormal protrusion of the eye)

Thyrotoxicosis symptoms:  may include – irritability,
hypertension, tachycardia, vomiting, temperature up to 106 degrees F.,
delirium, and coma

Other sings and symptoms include:

CNS:  difficulty concentrating, excitability, nervousness,
fine tremor, shaky handwriting, clumsiness, and mood swings.

Cardiovascular system:  tachycardia, full – bounding
pulse, wide pulse pressure, increased cardiac output and blood volume,
cardiomegaly, paroxysmal supraventricular tachycardia and atrial fibrillation
(more so in elderly patients), 

Eyes:  exophthalmos, inflammation of conjunctivae,
corneas, or eye muscles; increased tearing, lid retraction, the perception
of two images of a single object (diplopia)

GI system:  increased appetite, but occasional anorexia,
increased defecation, soft stools or, with severe disease – diarrhea, and
liver enlargement..

Musculoskeletal system:  weakness, fatigue, and muscle
atrophy.  generalized or localized paralysis associated with hypokalemia;
soft tissue swelling

Reproductive system:  in females – oligomenorrhea
(abnormal infrequent menstrual cycle) or amenorrhea (absent or abnormal
stoppage of menstrual cycle); decreased fertility; higher incidence of
spontaneous abortions. 

In males:  gynecomastia (excessive development of the male mammary
glands, even to the functional state.)

Both sexes:  diminished libido

Respiratory system:  dyspnea (difficulty breathing)
on exertion and at rest rest

Skin, hair, and nails:  smooth, warm, paper thin, flashed
skin;  accentuated hair follicles; raised red patches of skin that
are itchy and sometimes painful, with occasional nodule formation; fine,
soft hair: premature graying and increased hair loss in both sexes; friable
nails and distal nail separated from the bed (onycholysis)


Treatment depends on the size of the goiter, the causes, the patient’s
age and parity, and how long surgery (if needed) will be delayed.

Antithyroid drugs

I, beta-adrenergic blockers

Surgery (if needed)