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Thyroid dysfunction can present as hypo- or hyperactive thyroidal function. Hypothyroidism is thyroid hormone deficiency. Primary hypothyroidism is due to thyroid disease; TSH is increased. Most common cause is autoimmune. Other common causes are post-therapeutic, occurring after radioactive iodine therapy, surgery, radiation, or lithium therapy. Secondary hypothyroidism occurs when hypothalamus produces insufficient TRH or pituitary produces insufficient TSH. Signs and symptoms of hypothyroidism include: cold intolerance, constipation, personality changes, dementia or frank psychosis, hoarse voice, facial puffiness, coarse hair and skin, fluid retention, decreased metabolism, paresthesias, decreased libido, menstrual irregularities, bradycardia, pericardial effusions. Hyperthyroidism is excessive production of iodinated thyroid hormones, T3 and T4. Graves\' disease (toxic diffuse goiter) is most common cause and is characterized by hyperthyroidism, goiter, exophthalmos, pretibial myxedema. Inflammatory thyroid disease (thyroiditis) includes subacute granulomatous thyroiditis, Hashimoto\'s thyroiditis, and silent lymphocytic thyroiditis. Drug-induced hyperthyroidism can result from lithium or interferon-alpha. Signs and symptoms of hyperthyroidism include: hyperactivity, increased sweating, increased appetite, weight loss, insomnia, weakness, frequent bowel movements, hypomenorrhea, tremor; tachycardia, atrial fibrillation. Eye signs include stare and eyelid retraction. Infiltrative ophthalmopathy is specific to Graves\' disease. Thyroid storm is life-threatening emergency; patients may present with fever, psychosis, coma, cardiovascular collapse.
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