Hyperthyroidism and Thyrotoxicosis Questions & Answers

Updated: Oct 19, 2020
  • Author: Stephanie L Lee, MD, PhD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Questions & Answers

Overview

What is hyperthyroidism?

What are the symptoms of hyperthyroidism and thyrotoxicosis?

What are the signs of thyrotoxicosis in hyperthyroidism?

What is the presentation of thyrotoxicosis in hyperthyroidism?

Which thyroid function tests are performed in the workup of hyperthyroidism and thyrotoxicosis?

Which thyroid function study results suggest hyperthyroidism and thyrotoxicosis?

Which autoantibody tests are performed in the workup of hyperthyroidism?

Which autoantibody titers suggest hyperthyroidism and thyrotoxicosis?

What is the role of scintigraphy in the workup of hyperthyroidism?

What are the treatment options for hyperthyroidism and thyrotoxicosis?

What are the indications for antithyroid drug therapy in the treatment of hyperthyroidism?

What is the role of radioactive iodine in the treatment of hyperthyroidism?

What are the indications for thyroidectomy in the treatment of hyperthyroidism?

What organizations have released guidelines for the management of hyperthyroidism?

What is hyperthyroidism?

What are the common forms of hyperthyroidism?

What is the most reliable screening measure of thyroid function in hyperthyroidism?

What are the treatment options for hyperthyroidism?

What is the role of thyrotropin-releasing hormone (TRH) in the pathogenesis of hyperthyroidism?

What is the role of iodine in the pathogenesis of hyperthyroidism?

How are thyroid hormones diffused in the pathophysiology of hyperthyroidism?

Which processes cause thyrotoxicosis in the pathophysiology of hyperthyroidism?

What is the pathogenesis of Graves disease?

What is the pathophysiology of Graves ophthalmopathy (thyroid-associated orbitopathy)?

What are the risk factors for Graves ophthalmopathy?

What are the risk factors for hyperthyroidism?

Which genetic syndromes may cause hyperthyroidism?

Which hyperthyroid disorders are caused by mutations in the TSHR gene?

Which disorder is associated with both hyperthyroidism and hypothyroidism?

Which forms of hyperthyroidism are human leukocyte antigen (HLA)-related?

Which risk factor for hyperthyroidism increases the risk for developing other endocrine autoimmune disorders?

Which genetic loci may increase the risk for Graves disease?

Which gene may be an etiologic agent in toxic multinodular goiter (Plummer disease)?

How does iodine cause hyperthyroidism?

What is the most common cause of thyrotoxicosis?

What is the role of thyroid stimulating antibodies (TSAb) in the etiology of hyperthyroidism?

Which clinical findings suggest Graves disease?

What are the potential fetal or neonatal complications in pregnant women with Graves disease?

After Graves disease, what is the most common cause of thyrotoxicosis?

What is the prevalence of toxic multinodular goiter (Plummer disease) thyrotoxicosis?

What are the signs and symptoms of toxic multinodular goiter (Plummer disease)-related thyrotoxicosis?

What causes toxic adenoma?

What is struma ovarii?

How does iodide-induced thyrotoxicosis (Jod-Basedow syndrome) occur?

What are rare causes of thyrotoxicosis?

What is the most common form of hyperthyroidism and what is its incidence in the US?

What is the incidence of toxic multinodular goiter (Plummer disease in the US?

How does iodine intake affect the incidences of Graves disease and toxic multinodular goiter?

How does the incidence of hyperthyroidism vary among races?

How does the incidence of hyperthyroidism vary between males and females?

How does the incidence of hyperthyroidism vary by age, and what are the morbidities associated with hyperthyroidism?

What are the treatment options for toxic multinodular goiter and toxic adenoma?

What is the prognosis of hyperthyroidism?

What is the prognosis of Graves disease?

What is the sequelae of hyperthyroidism?

What are possible skeletal complications of hyperthyroidism?

What is the typical disease progression of hyperthyroidism?

Presentation

How does the presentation of thyrotoxicosis vary among age groups?

What are the common symptoms of thyrotoxicosis?

How is hyperthyroidism diagnosed?

When should the diagnosis of Graves disease be considered?

Which factors increase the risk of developing toxic multinodular goiters?

How is subclinical hyperthyroidism defined?

When may the risk of atrial fibrillation be elevated in patients with hyperthyroidism?

What is the role of radiation exposure in the development of hyperthyroidism?

What should be the focus of family history in patients with suspected hyperthyroidism?

Which compounds can induce thyrotoxicosis in patients with thyroid autonomy?

How is the thyroid described in a physical exam for suspected hyperthyroidism?

What are the signs of thyrotoxicosis?

Which physical findings suggest Graves thyrotoxicosis?

Which physical findings suggest toxic multinodular goiters?

Which diagnoses should be considered when the thyroid is enlarged and painful on physical exam for hyperthyroidism?

What is the prevalence of thyroid ophthalmopathy in patients with Graves thyrotoxicosis?

What are the dermatologic manifestations of Graves disease?

DDX

Which conditions should be included in the differential diagnoses for hyperthyroidism?

What are the differential diagnoses for Hyperthyroidism and Thyrotoxicosis?

Workup

What is the most reliable screening measure of thyroid function?

What is the role of anti ? thyroid peroxidase (anti-TPO) antibody testing in the workup of hyperthyroidism?

What is the role of scintigraphy in the workup of hyperthyroidism?

What is the role of electrocardiography (EKG) in the workup of hyperthyroidism?

How is thyrotoxicosis measured in the workup of hyperthyroidism?

What is the role of thyroxine (T4) and triiodothyronine (T3) measurement in the workup of hyperthyroidism?

How is subclinical hyperthyroidism defined?

Which factors may complicate the interpretation of thyroid function tests in the workup of hyperthyroidism?

Is anti-thyroid peroxidase (anti-TPO) antibody testing used in hyperthyroidism screening?

What is the role of thyroid-stimulating immunoglobulin (TSI) measurement in the workup of hyperthyroidism?

What is role of scintigraphy in the workup of hyperthyroidism?

Which scintigraphy findings suggest Graves disease?

Which scintigraphy findings suggest toxic multinodular goiters?

How are nodules classified in scintigraphy results of hyperthyroidism?

Which scintigraphy findings suggest subacute thyroiditis?

Treatment

What are the treatment options for hyperthyroidism and thyrotoxicosis?

What are possible adverse effects of antithyroid medications for hyperthyroidism?

Which organizations have developed guidelines for the management of hyperthyroidism?

How are the ophthalmologic manifestations of hyperthyroidism treated?

What is the treatment for exposure keratitis in patients with hyperthyroidism?

What ophthalmologic emergency may occur in patients with hyperthyroidism?

What is the presentation of dermopathy (dermatologic symptoms) in patients with hyperthyroidism?

How is dermopathy treated in patients with hyperthyroidism?

What is the role of beta-blocker therapy in the treatment of hyperthyroidism?

What is the role of calcium channel blockers in the treatment of hyperthyroidism?

Which drugs are used in the treatment of hyperthyroidism?

How do antithyroid medications work to treat hyperthyroidism?

What is the dosage regimen for antithyroid medication in the treatment of hyperthyroidism?

What is the role of methimazole in the treatment of hyperthyroidism?

What is the role of propylthiouracil in the treatment of hyperthyroidism?

When is propylthiouracil indicated in the treatment of hyperthyroidism?

What are the possible adverse effects of antithyroid drugs in the treatment of hyperthyroidism?

What is the presentation of agranulocytosis in patients with hyperthyroidism?

What is the FDA warning for the use of propylthiouracil in hyperthyroidism treatment?

What are the FDA recommended measures for patients receiving propylthiouracil in the treatment of hyperthyroidism?

What is the role of iodine or iodinated contrast agents in the treatment of hyperthyroidism?

What is the role of cholestyramine in the treatment of hyperthyroidism?

What is the most common treatment for Graves disease in the US?

What are the ATA recommendations for radioactive iodine therapy in the treatment of hyperthyroidism?

How is radioactive iodine administered in the treatment of hyperthyroidism?

What dosage is administered for radioactive iodine therapy for hyperthyroidism?

What is the role of lithium in the treatment of hyperthyroidism?

What is the goal of radioactive iodine therapy in the treatment of hyperthyroidism?

What are the ATA recommendations for use of radioactive iodine therapy in the treatment of hyperthyroidism in children and adolescents?

What are the contraindications to radioactive iodine therapy for hyperthyroidism?

What is standard practice before starting radioactive iodine therapy for hyperthyroidism?

Can patients with severe ophthalmopathy receive radioactive iodine in the treatment of hyperthyroidism?

What is the oldest form of treatment for hyperthyroidism?

What is the role of thyroidectomy in the treatment of hyperthyroidism?

What is included in the preparation for thyroidectomy in the treatment of hyperthyroidism?

What is the role of dexamethasone in the treatment of hyperthyroidism?

What are adverse effects of thyroidectomy in the treatment of hyperthyroidism?

How do the benefits of endoscopic thyroidectomy compare to conventional open thyroidectomy in the treatment of Graves disease?

Which foods, agents, and supplements should be avoided during treatment for hyperthyroidism?

When is a decrease in activity indicated in the treatment of hyperthyroidism?

How can exercise tolerance be improved in patients with severe thyrotoxicosis?

Which specialist consultations are needed in the treatment of thyrotoxicosis?

Who should provide care for patients who have completed definitive therapy for hyperthyroidism?

Which specialist consultations are needed in the treatment of patients with Graves thyrotoxicosis?

What monitoring is needed after the initiation of antithyroid medication for Graves disease?

What monitoring is needed after the initiation of antithyroid medication for non-Graves hyperthyroidism?

When should antithyroid medication for Graves disease be reduced or stopped?

When should definitive treatment be considered for patients with Graves disease?

What monitoring is needed after radioactive iodine therapy for hyperthyroidism?

What monitoring is needed after thyroid surgery for hyperthyroidism?

Guidelines

What are the 2016 ATA guidelines for the management of hyperthyroidism/thyrotoxicosis?

What are the 2017 ATA guidelines for the diagnosis and management of thyroid disease in women during pregnancy, the postpartum period, and preconception?

Medications

What is the drug therapy for hyperthyroidism?

How are patients with hyperthyroidism treated?

Which patients with hyperthyroidism continue to be thyrotoxic after treatment with antithyroid medications?

Which medications in the drug class Beta Blockers, Beta1-Selective are used in the treatment of Hyperthyroidism and Thyrotoxicosis?

Which medications in the drug class Beta Blockers, Nonselective are used in the treatment of Hyperthyroidism and Thyrotoxicosis?

Which medications in the drug class Antithyroid Agents are used in the treatment of Hyperthyroidism and Thyrotoxicosis?