Hyperhidrosis

Hyperhidrosis is the condition characterized by abnormally increased sweating/perspiration, in excess of that required for regulation of body temperature. Hyperhidrosis can either be generalized or localized to specific parts of the body. Hands, feet, armpits, and the groin area are among the most active regions of perspiration due to the relatively high concentration of sweat glands. When excessive sweating is localized it is referred to as primary or focal hyperhidrosis. Generalized or secondary hyperhidrosis usually involves the body as a whole and is the result of an underlying condition. Hyperhidrosis can also be classified depending by onset, either congenital or acquired. Primary or focal hyperhidrosis is found to start during adolescence or even before and seems to be inherited as an autosomal dominant genetic trait. Primary or focal hyperhidrosis must be distinguished from secondary hyperhidrosis, which can start at any point in life. The later form may be due to a disorder of thethyroid or pituitary glands, diabetes mellitus, tumors, gout, menopause, certain drugs, or mercury poisoning. Hyperhidrosis may also be divided into palmoplantar (symptomatic sweating of primarily the hands or feet), gustatory and generalized hyperhidrosis. Alternatively, hyperhidrosis may be classified according to the amount of skin affected and its possible 2 causes. In this approach, excessive sweating in an area greater than 100 cm (16 sq in) (up to generalized sweating of the entire body) is differentiated from sweating that affects only a small area.

Cause
The cause of primary hyperhidrosis is unknown, although some surgeons claim it is caused by sympathetic over-activity. Nervousness or excitement can exacerbate the situation for many sufferers. Other factors can play a role; certain foods and drinks, nicotine, caffeine, and smells can trigger a response.

Hyperthyroidism
Hyperthyroidism, or overactive thyroid, is the overproduction of the thyroid hormones T 3 and T4, and is most commonly caused by the development of Graves' disease, an autoimmune disease in which antibodies are produced which stimulate the thyroid to secrete excessive quantities of thyroid hormones. The disease can result in the formation of a toxic goiter as a result of thyroid growth in response to a lack of negative feedback mechanisms. It presents with symptoms such as a thyroid goiter, protruding eyes (exopthalmos), palpitations, excess sweating, diarrhea, weight loss, muscle weakness and unusual sensitivity to heat. The appetite is often increased. Beta blockers are used to decrease symptoms of hyperthyroidism such as increased heart rate, tremors, anxiety and heart palpitations, and anti-thyroid drugs are used to decrease the production of thyroid hormones, in particular, in the case of Graves' disease. These medications take several months to take full effect and have side-effects such as skin rash or a drop in white blood cell count, which decreases the ability of the body to fight off infections. These drugs involve frequent dosing (often one pill every 8 hours) and often require frequent doctor visits and blood tests to monitor the treatment, and may sometimes lose effectiveness over time. Due to the side-effects and inconvenience of such drug regimens, some patients choose to undergo radioactive iodine-131treatment. Radioactive iodine is administered in order to destroy a portion of or the entire thyroid gland, since the radioactive iodine is selectively taken up by the gland and gradually destroys the cells of the gland. Alternatively, the gland may be partially or entirely removed surgically, though iodine treatment is usually preferred since the surgery is invasive and carries a risk of damage to the parathyroid glands or the nerves controlling the vocal cords. If the entire thyroid gland is removed, hypothyroidism results.

Needs Thyroid function tests

Specialist: Endocrinologists

Thyroid function tests

Test

Abbreviation

Normal ranges

Serum thyrotropin/thyroid-stimulating hormone TSH

0.33.0 U/ml

Free thyroxine

FT4

718 ng/l = 0.71.8 ng/dl

Serum triiodothyronine

T3

0.81.8 g/l = 80180 ng/dl

Radioactive iodine-123 uptake

RAIU

1030%

Radioiodine scan (gamma camera)

N/A

N/A - thyroid contrasted images

Free thyroxine fraction

FT4F

0.030.005%

Serum thyroxine

T4

46120 g/l = 4.612.0 g/dl

Thyroid hormone binding ratio

THBR

0.91.1

Free thyroxine index

FT4I

411

Free triiodothyronine l

FT3

230619 pg/d

Free T3 Index

FT3I

80180

Thyroxine-binding globulin

TBG

1220 ug/dl T4 +1.8 g

TRH stimulation test

Peak TSH

930 IU/ml at 2030 min.

Serum thyroglobulin l

Tg

0-30 ng/m

Thyroid microsomal antibody titer

TMAb

Varies with method

Thyroglobulin antibody titer

TgAb

Varies with method

U/ml = mU/l, microunit per milliliter ng/dl, nanograms per deciliter g, micrograms pg/d, picograms per day IU/ml = mIU/l, micro-international unit per milliliter See [2] for more information on medical units of measure