eMedicine Specialties > Endocrinology > Thyroid

Hyperthyroidism: Multimedia

Author: Stephanie L Lee, MD, PhD, Fellow, Association of Clinical Endocrinology; Director of Thyroid Nodule and Cancer Center, Associate Chief, Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center; Associate Professor, Department of Medicine, Boston University School of Medicine
Coauthor(s): Sonia Ananthakrishnan, MD, Attending Physician, Department of Medicine, Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine/Boston Medical Center
Contributor Information and Disclosures

Updated: Jun 8, 2009

Multimedia

Iodine 123 (<SUP><FONT size=-1>123</FONT></SUP>I)...
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Media file 1: Iodine 123 (123I) nuclear scintigraphy: 123I scans of a normal thyroid gland (A) and common hyperthyroid conditions with elevated radioiodine uptake, including Graves disease (B), toxic multinodular goiter (C), and toxic adenoma (D).
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Iodine 123 (<SUP><FONT size=-1>123</FONT></SUP>I)...

Iodine 123 (123I) nuclear scintigraphy: 123I scans of a normal thyroid gland (A) and common hyperthyroid conditions with elevated radioiodine uptake, including Graves disease (B), toxic multinodular goiter (C), and toxic adenoma (D).

Color flow ultrasonogram in a patient with Graves...
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Media file 2: Color flow ultrasonogram in a patient with Graves disease. Generalized hypervascularity is visible throughout the gland, which often can be heard as a hum or bruit with a stethoscope.
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Color flow ultrasonogram in a patient with Graves...

Color flow ultrasonogram in a patient with Graves disease. Generalized hypervascularity is visible throughout the gland, which often can be heard as a hum or bruit with a stethoscope.

Absence of iodine 123 (<SUP><FONT size=-1>123</FO...
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Media file 3: Absence of iodine 123 (123I) radioactive iodine uptake in a patient with thyrotoxicosis and subacute painless or lymphocytic thyroiditis. Laboratory studies at the time of the scan demonstrated the following: thyroid-stimulating hormone (TSH), less than 0.06 mIU/mL; total thyroxine (T4), 21.2 mcg/dL (reference range, 4.5-11); total triiodothyronine (T3), 213 ng/dL (reference range, 90-180); T3-to-T4 ratio, 10; and erythrocyte sedimentation rate (ESR), 10 mm/h. The absence of thyroid uptake, the low T3-to-T4 ratio, and the low ESR confirm the diagnosis of subacute painless thyroiditis.
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Absence of iodine 123 (<SUP><FONT size=-1>123</FO...

Absence of iodine 123 (123I) radioactive iodine uptake in a patient with thyrotoxicosis and subacute painless or lymphocytic thyroiditis. Laboratory studies at the time of the scan demonstrated the following: thyroid-stimulating hormone (TSH), less than 0.06 mIU/mL; total thyroxine (T4), 21.2 mcg/dL (reference range, 4.5-11); total triiodothyronine (T3), 213 ng/dL (reference range, 90-180); T3-to-T4 ratio, 10; and erythrocyte sedimentation rate (ESR), 10 mm/h. The absence of thyroid uptake, the low T3-to-T4 ratio, and the low ESR confirm the diagnosis of subacute painless thyroiditis.

Three multinuclear giant cell granulomas observed...
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Media file 4: Three multinuclear giant cell granulomas observed in a fine-needle aspiration biopsy of the thyroid from a patient with thyrotoxicosis from subacute painful or granulomatous thyroiditis.
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Three multinuclear giant cell granulomas observed...

Three multinuclear giant cell granulomas observed in a fine-needle aspiration biopsy of the thyroid from a patient with thyrotoxicosis from subacute painful or granulomatous thyroiditis.

Scan in a patient with a toxic multinodular goite...
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Media file 5: Scan in a patient with a toxic multinodular goiter. The 5-hour iodine uptake was elevated at 28%. Note the multiple foci of variably increased tracer uptake.
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Scan in a patient with a toxic multinodular goite...

Scan in a patient with a toxic multinodular goiter. The 5-hour iodine uptake was elevated at 28%. Note the multiple foci of variably increased tracer uptake.

Severe proptosis and eyelid retraction from thyro...
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Media file 6: Severe proptosis and eyelid retraction from thyroid-related orbitopathy. This patient also had optic nerve dysfunction from thyroid related orbitopathy.
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Severe proptosis and eyelid retraction from thyro...

Severe proptosis and eyelid retraction from thyroid-related orbitopathy. This patient also had optic nerve dysfunction from thyroid related orbitopathy.

More on Hyperthyroidism

Overview: Hyperthyroidism
Differential Diagnoses & Workup: Hyperthyroidism
Treatment & Medication: Hyperthyroidism
Follow-up: Hyperthyroidism
Multimedia: Hyperthyroidism
References
Further Reading
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References

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  2. [Best Evidence] Heeringa J, Hoogendoorn EH, van der Deure WM, et al. High-normal thyroid function and risk of atrial fibrillation: the Rotterdam study. Arch Intern Med. Nov 10 2008;168(20):2219-24. [Medline].

  3. FDA MedWatch Safety Alerts for Human Medical Products. Propylthiouracil (PTU). US Food and Drug Administration. Available at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm164162.htm. Accessed June 3, 2009.

  4. Stalberg P, Svensson A, Hessman O, et al. Surgical treatment of Graves' disease: evidence-based approach. World J Surg. Jul 2008;32(7):1269-77. [Medline].

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  6. [Best Evidence] Worni M, Schudel HH, Seifert E, et al. Randomized controlled trial on single dose steroid before thyroidectomy for benign disease to improve postoperative nausea, pain, and vocal function. Ann Surg. Dec 2008;248(6):1060-6. [Medline].

  7. Porterfield JR Jr, Thompson GB, Farley DR, et al. Evidence-based management of toxic multinodular goiter (Plummer's Disease). World J Surg. Jul 2008;32(7):1278-84. [Medline].

  8. Allahabadia A, Daykin J, Holder RL. Age and gender predict the outcome of treatment for Graves' hyperthyroidism. J Clin Endocrinol Metab. Mar 2000;85(3):1038-42. [Medline]. [Full Text].

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Keywords

hyperthyroidism, thyroid, TSH, Graves disease, hyperthyroid, thyroiditis, thyroid hormone, thyroid nodule, thyroid function, thyroid treatment, thyroid goiter, thyroid medication, thyroid medicine, thyroid problem, thyroidectomy, enlarged thyroid, thyroid-stimulating hormone, thyroid problems symptoms, thyrotoxicosis, diffuse toxic goiter, Graves' disease, Hashimoto thyroiditis, toxic multinodular goiter, toxic multi-nodular goiter, Plummer disease, Plummer's disease, subacute thyroiditis, toxic adenoma, iodide-induced thyrotoxicosis, thyrotoxicosis factitia, thyroid-stimulating hormone, thyroid carcinoma, struma ovarii with thyrotoxicosis, antithyroid medication, anti-thyroid medication, radioactive iodine therapy, iodine radiotherapy, elevated levels of free thyroxine, elevated levels of free triiodothyronine, molar hydatidiform pregnancy, choriocarcinoma, pituitary tumors, metastatic thyroid carcinoma, heat intolerance, oligomenorrhea, unexplained weight loss, lid lag, sinus tachycardia, atrial fibrillation, high output failure, fine tremor, muscle weakness, anxiety, thyroid ophthalmopathy, pernicious anemia, periorbital edema, chemosis, conjunctival edema, conjunctival injection, proptosis, myasthenia gravis, vitiligo, adrenal insufficiency, type I diabetes mellitus, apathetic hyperthyroidism, follicular thyroid adenoma, toxic thyroid adenoma, Jod-Basedow syndrome, dermoid tumors, ovarian teratomas, congestive heart failure, CHF, left ventricular thickening, dermopathy, extraocular muscle dysfunction, diplopia, swelling of the pretibial area, tachycardia, atrial arrhythmia, systolic hypertension, rheumatoid arthritis, nontoxic goiter, thyroid autonomy, granulomatous thyroiditis, HLA-DRw3, HLA-B89, Hashimoto hypothyroidism

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Contributor Information and Disclosures

Author

Stephanie L Lee, MD, PhD, Fellow, Association of Clinical Endocrinology; Director of Thyroid Nodule and Cancer Center, Associate Chief, Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center; Associate Professor, Department of Medicine, Boston University School of Medicine
Stephanie L Lee, MD, PhD is a member of the following medical societies: American College of Endocrinology, American Thyroid Association, and Endocrine Society
Disclosure: Nothing to disclose.

Coauthor(s)

Sonia Ananthakrishnan, MD, Attending Physician, Department of Medicine, Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine/Boston Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Frederick H Ziel, MD, Associate Professor of Medicine, David Geffen School of Medicine at UCLA; Physician-In-Charge, Endocrinology/Diabetes Center, Director of Medical Education, Kaiser Permanente Woodland Hills; Chair of Endocrinology, Co-Chair of Diabetes Complete Care Program, Southern California Permanente Medical Group
Frederick H Ziel, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Endocrinology, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Federation for Medical Research, American Medical Association, American Society for Bone and Mineral Research, California Medical Association, Endocrine Society, and International Society for Clinical Densitometry
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Yoram Shenker, MD, Chief of Endocrinology Section, Veterans Affairs Medical Center of Madison; Interim Chief, Associate Professor, Department of Internal Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Wisconsin at Madison
Yoram Shenker, MD is a member of the following medical societies: American Heart Association, Central Society for Clinical Research, and Endocrine Society
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, St Louis University School of Medicine
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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