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, and 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 disorder.


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) 

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