1. Demographics
   1. 29 years old
   2. general manager
2. Complains
   1. palpitations
   2. losing weight
      1. causes
         1. Loss of appetite
            1. painful mouth sores
            2. dysphagia
            3. newly applied orthodontic appliances
            4. loss of teeth
         2. Persistent vomiting, eg pyloric stenosis, hiatus hernia.
         3. Malabsorption
         4. Medication
         5. Malignancy
         6. Systemic disease
         7. Acute infection
         8. Chronic infections
         9. Drug abuse, heavy smoking.
         10. Malnutrition, social isolation.
         11. Psychological
             1. stressful life events
             2. depression
             3. anorexia nervosa
   3. increased appetite
3. P/E
   1. swollen neck glands
      1. thyroid gland
         1. anatomy
            1. location
            2. muscular trianlge of the neck Deep to the sternohyoid muscle and Sternothyroid muscle.
            3. shape
            4. two pear-shaped lobes, connected by an isthmus
         2. blood supply
            1. Superior thyroid vein
            2. middle thyroid vein
            3. inferior thyroid vein
4. History
   1. family history
      1. heart attack
   2. stressed
   3. Medical history
      1. controlled asthma
5. Diagnosis
   1. Hyperthyroidism
      1. Definition
         1. overactive thyroid gland
      2. occur to whom ?
         1. females more than males
         2. any age
      3. Causes
         1. Graves' disease
         2. Thyroid nodules
         3. medications
            1.  amiodarone
            2. lithium
      4. Types
         1. Primary
            1. Grave’s Disease
            2. Multinodular Goiter
            3. Thyroid adenoma
         2. Secondary
            1. Pituitary Thyrotroph Adenomas
            2. Excess Exogenous TH
            3. Thyroiditis
      5. S & Sx
         1. Anxiety
         2. Irritability
         3. Difficulty sleeping
         4. A rapid or irregular heartbeat
         5. A fine tremor of your hands or fingers
         6. warm, moist skin
         7. Weight loss, despite normal eating habits
         8. Enlargement of your thyroid gland (goiter)
         9. Thick, red skin (Graves' dermopathy)
      6. Diagnosis
         1. Medical history and physical exam
         2. Blood tests
            1. T4
            2. TSH
            3. TRH
            4. Antithyroid peroxidase (aTPO)
            5. Full blood count
         3. Thyroid Ultrasound
         4. Thyroid scan
      7. Pathogenesis
      8. Complications
         1. Heart problems.
            1. Atrial fibrillation
            2. congestive heart failure
         2. bones
            1. osteoporosis
         3. ophthalmopathies
            1. Bulging
            2. red or swollen eyes
            3. sensitivity to light
            4. blurring or double vision
            5. Untreated, severe eye problems can lead to vision loss.
         4. Skin (dermopathy), often the chins and feet
            1. Red
            2. Swollen
         5. Thyrotoxic crisis
      9. Treatment
         1. Anti-thyroid drug therapy
            1. Methimazole
            2. propylthiouracil
         2. Surgical thyroidectomy
         3. Destruction of the gland with radioactive iodine