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Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Hyperthyroidism


Text Only Home | Graphic-Rich Site | Definition | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Complications | Factors Influencing Duration | Length of Disability | Return to Work | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
242.1 - Thyrotoxicosis with or without Goiter; Toxic Uninodular Goiter; Thyroid Nodule, Toxic or with Hyperthyroidism; Uninodular Goiter, Toxic or with Hyperthyroidism
242.10 - Thyrotoxicosis with or without Goiter; Toxic Uninodular Goiter; Thyroid Nodule, Toxic or with Hyperthyroidism; Uninodular Goiter, Toxic or with Hyperthyroidism; without Mention of Thyrotoxic Crisis or Storm
242.11 - Thyrotoxicosis with or without Goiter; Toxic Uninodular Goiter; Thyroid Nodule, Toxic or with Hyperthyroidism; Uninodular Goiter, Toxic or with Hyperthyroidism; with Mention of Thyrotoxic Crisis or Storm
242.2 - Thyrotoxicosis with or without Goiter; Toxic Multinodular Goiter; Secondary Thyroid Hyperplasia
242.20 - Thyrotoxicosis with or without Goiter; Toxic Multinodular Goiter; Secondary Thyroid Hyperplasia; without Mention of Thyrotoxic Crisis or Storm
242.21 - Thyrotoxicosis with or without Goiter; Toxic Multinodular Goiter; Secondary Thyroid Hyperplasia; with Mention of Thyrotoxic Crisis or Storm
242.3 - Thyrotoxicosis with or without Goiter; Toxic Nodular Goiter, Unspecified; Adenomatous Goiter, Toxic or with Hyperthyroidism; Nodular Goiter, Toxic or with Hyperthyroidism; Struma Nodosa, Toxic or with Hyperthyroidism
242.30 - Thyrotoxicosis with or without Goiter; Toxic Nodular Goiter, Unspecified; Adenomatous Goiter, Toxic or with Hyperthyroidism; Nodular Goiter, Toxic or with Hyperthyroidism; Struma Nodosa, Toxic or with Hyperthyroidism; without Mention of Thyrotoxic Crisis or Storm
242.31 - Thyrotoxicosis with or without Goiter; Toxic Nodular Goiter, Unspecified; Adenomatous Goiter, Toxic or with Hyperthyroidism; Nodular Goiter, Toxic or with Hyperthyroidism; Struma Nodosa, Toxic or with Hyperthyroidism; with Mention of Thyrotoxic Crisis or Storm
242.8 - Thyrotoxicosis with or without Goiter; Thyrotoxicosis of Other Specified Origin; Overproduction of Thyroid-stimulating Hormone [TSH] Thyrotoxicosis, Factitia from Ingestion of Excessive Thyroid Material
242.80 - Thyrotoxicosis with or without Goiter; Thyrotoxicosis of Other Specified Origin; Overproduction of Thyroid-stimulating Hormone [TSH] Thyrotoxicosis, Factitia from Ingestion of Excessive Thyroid Material; without Mention of Thyrotoxic Crisis or Storm
242.81 - Thyrotoxicosis with or without Goiter; Thyrotoxicosis of Other Specified Origin; Overproduction of Thyroid-stimulating Hormone [TSH] Thyrotoxicosis, Factitia from Ingestion of Excessive Thyroid Material; with Mention of Thyrotoxic Crisis or Storm
242.9 - Thyrotoxicosis without Mention of Goiter or Other Cause; Hyperthyroidism NOS; Thyrotoxicosis NOS
242.90 - Thyrotoxicosis without Mention of Goiter or Other Cause; Hyperthyroidism NOS; Thyrotoxicosis NOS; without Mention of Thyrotoxic Crisis or Storm
242.91 - Thyrotoxicosis without Mention of Goiter or Other Cause; Hyperthyroidism NOS; Thyrotoxicosis NOS; with Mention of Thyrotoxic Crisis or Storm

Related Terms

  • Overactive Thyroid

Overview

Hyperthyroidism is a condition in which the thyroid gland is overactive. The thyroid gland is located in the front of the neck near the Adam's apple. This gland produces hormones (thyroid hormones) that play an important role in controlling the body's functions (e.g., heart rate and metabolism).

There are several different causes of hyperthyroidism. The most common is called Graves' disease. Other causes include inflammation of the thyroid gland (thyroiditis), enlargement of the thyroid with many small growths (toxic multinodular goiter), a single overactive thyroid growth, and overdose of the medication used to treat an underactive thyroid (thyroid hormone pills). In rare cases, hyperthyroidism can result from tumors of the pituitary gland or other tumors, or as a side effect of certain medications that interfere with the body's levels of iodine.

Incidence and Prevalence: Hyperthyroidism affects approximately 1% of individuals in the US (Braverman 949). It can occur at any age and in both sexes but is more common in women after childbirth and during menopause.

Source: Medical Disability Advisor



Diagnosis

History: There may be a family history of hyperthyroidism. The individual may report a pounding or rapidly beating heart, a fluttering in the chest (heart palpitations), increased sensitivity to heat, excessive sweating, increased appetite with unintentional weight loss, changes in menstrual patterns, and shakiness (tremor) of the hands. Many individuals report that they feel nervous, restless, anxious, tired, or weak. They may have difficulty sleeping yet have increased activity levels. More frequent bowel movements and occasional diarrhea are also common. Difficulty swallowing can occur in the setting of an enlarged thyroid (goiter).

Physical exam: The exam may reveal elevated blood pressure (hypertension) and increased heart rate. An irregular heart rhythm (atrial fibrillation) may be present, especially in the elderly. Reflexes are very brisk. The eyes may appear to bulge (exophthalmos), with eyelids wide open. The skin may be warm and moist. A tremor can be seen in the hands and tongue. Enlargement of the thyroid gland (goiter) is often noted. The elderly are more likely to have fewer symptoms or more subtle symptoms such as intolerance to heat, making the condition harder to diagnose.

Tests: Blood tests reveal abnormal levels of thyroid hormones. The blood cholesterol is often low. An electrocardiogram (ECG) can identify heart rhythm abnormalities. The thyroid can be inspected for uptake using the radioactive iodine uptake test. In this test, the individual is given a small quantity of a radioactive chemical (either orally or by injection). The chemical is absorbed by either healthy or diseased tissue (depending on the disease process and type of scan). The emitted radioactivity produces an image of the thyroid on film, enabling the physician to evaluate abnormalities and diagnose the cause of hyperthyroidism.

Source: Medical Disability Advisor



Treatment

Most cases are treated with medications that interfere with the thyroid hormones (antithyroid medications). Once the excess thyroid hormones are controlled, the majority of symptoms will decrease or disappear. Other medications (beta-blockers) may also be prescribed to alleviate rapid heartbeat and trembling. Antithyroid medications are usually given for 3 to 12 months; thyroid levels are then re-evaluated. Depending on the results, medication may be resumed, modified, or discontinued. In some cases, radioactive iodine therapy may be indicated. It is never given to pregnant or nursing women. Surgical removal of a portion of the thyroid gland (partial or subtotal thyroidectomy) is rare but can be especially helpful in cases of a single toxic nodule when the rest of the gland is completely suppressed. Thyroidectomy is effective in approximately 90% of cases (Braverman 952) and eliminates the need for lifelong thyroid hormones.

Patients with Graves' disease may require additional treatments for eye and skin symptoms (e.g., corticosteroids and, in some cases, eye surgery).

Source: Medical Disability Advisor



Prognosis

Hyperthyroidism is usually treatable with no long-term adverse effects. Side effects of medications used to treat hyperthyroidism may be more problematic in older individuals. Surgical removal of a portion of the thyroid (subtotal thyroidectomy) is generally effective but can result in inadequate production of thyroid hormone in the body. Older individuals are also at increased risk for complications such as cardiac failure.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Endocrinologist
  • General Surgeon
  • Nuclear Medicine Specialist
  • Ophthalmologist

Source: Medical Disability Advisor



Complications

Bulging eyes may develop despite adequate treatment of hyperthyroidism. Underactive thyroid function (hypothyroidism) can result after treatment of hyperthyroidism. Heart rhythm disturbances and high-output heart failure are other possible complications. Older individuals are more likely to experience cardiac failure. Muscle weakness and bone demineralization can occur. In individuals with untreated or undertreated hyperthyroidism, infection, injury, uncontrolled diabetes, and various other stresses may trigger sudden and extreme overactivity of the thyroid gland (thyroid storm), which is almost always fatal if not treated promptly.

Source: Medical Disability Advisor



Factors Influencing Duration

The individual's age and the underlying cause of the disease may influence the length of disability. The length of disability depends on the type of treatment administered and the individual's response to therapy. The development of hypothyroidism after treatment will prolong recovery.

If radioactive treatment is used, extended sick leave may be required if the individual experiences significant post-iodine thyroiditis and exacerbation of hyperthyroidism. After treatment, disability due to underactive thyroid (hypothyroidism) may occur, with symptoms of severe fatigue, cold intolerance, and unexplained weight gain.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

In general, work restrictions and accommodations are not necessary. Individuals with bulging eyes (exophthalmos) have eye irritation, increased tearing, possible eye pain, and increased sensitivity to bright light, dust, fumes, or wind. Depending on the individual's job requirements, special eyewear may be helpful. Frequent breaks to instill eyedrops may also be necessary. If surgery is required for treatment of hyperthyroidism, extended sick leave may be required for recovery from the procedure. If radioactive treatment is used, extended sick leave may be required if the individual experiences significant post-iodine thyroiditis and exacerbation of hyperthyroidism.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual have a family history of hyperthyroidism?
  • Does individual have Graves' disease, thyroiditis, toxic multinodular goiter, or a single overactive thyroid growth? Has individual taken too many thyroid hormone pills?
  • Does individual have tumors of the pituitary gland or other tumors? Have side effects of certain medications interfered with individual's iodine levels?
  • Does individual report heart palpitations, increased sensitivity to heat, excessive sweating, increased appetite, difficulty swallowing, or unintentional weight loss?
  • Does individual report feeling nervous, restless, anxious, tired, or weak yet having increased activity levels? Does individual report shakiness (tremor) in hands?
  • Does individual report frequent bowel movements or occasional diarrhea?
  • On exam, did individual have hypertension, tachycardia, or atrial fibrillation?
  • Did individual have brisk reflexes, warm moist skin, tremor in hands and tongue, goiter, or bulging eyes with eyelids wide open?
  • Has individual had complete thyroid hormone testing, cholesterol testing, ECG, and radioactive iodine uptake test?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Is individual being treated with antithyroid medications? Beta-blockers?
  • Was individual treated with radioactive iodine therapy?
  • Was a subtotal thyroidectomy performed?
  • Is individual compliant with treatment regimen?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have any conditions that may affect the ability to recover?
  • Does individual have any complication such as exophthalmos, hypothyroidism, heart rhythm disturbances, high-output heart failure, muscle weakness, or bone demineralization? Has individual had a thyroid storm?

Source: Medical Disability Advisor



References

Cited

Braverman, Lewis E. "Hyperthyroidism." The Merck Manual of Home Health Care. Ed. Mark H. Beers. 2nd ed. Whitehouse Station, NJ: Merck Research Laboratories, 2003. 949-952.

Source: Medical Disability Advisor