Overview
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 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 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?
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?
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?
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 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?
How is subclinical hyperthyroidism defined?
Is anti-thyroid peroxidase (anti-TPO) antibody testing used in hyperthyroidism screening?
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 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 contraindications to radioactive iodine therapy for hyperthyroidism?
What is standard practice before starting radioactive iodine therapy for 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?
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?
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?
Medications
What is the drug therapy for hyperthyroidism?
How are patients with hyperthyroidism treated?
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Severe proptosis, periorbital edema, and eyelid retraction from thyroid-related orbitopathy. This patient also had optic nerve dysfunction and chemosis (conjunctival edema) from thyroid-related orbitopathy.
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Color flow ultrasonogram in patient with Graves disease. Generalized hypervascularity is visible throughout gland (note red areas), which often can be heard as hum or bruit with stethoscope.
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Absence of iodine 123 (123I) radioactive iodine uptake in patient with thyrotoxicosis and subacute painless or lymphocytic thyroiditis. Laboratory studies at time of scan demonstrated the following: thyroid-stimulating hormone (TSH), less than 0.06 mIU/mL; total thyroxine (T4), 21.2 µg/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/hr. Absence of thyroid uptake, low T3-to-T4 ratio, and low ESR confirm diagnosis of subacute painless thyroiditis.
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Three multinuclear giant cell granulomas observed in fine-needle aspiration biopsy of thyroid from patient with thyrotoxicosis from subacute painful or granulomatous thyroiditis.
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Scan in patient with toxic multinodular goiter. 5-Hour 123I-iodine uptake was elevated at 28% (normal 5-15%). Note multiple foci of variably increased tracer uptake.
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Iodine 123 (123I) nuclear scintigraphy: 123I scans of 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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Gross photo of subtotal thyroidectomy for diffuse toxic goiter (Graves Disease) showing homogenous enlargement without nodules.
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Low-power photomicrograph showing diffuse papillary hyperplasia (hallmark histologic feature of Graves disease).
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High-power photomicrograph showing papillary hyperplasia of follicular cells with increased nuclear size and small nucleoli.
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Bilateral erythematous infiltrative plaques on lower extremities in 42-year-old man with Graves disease are consistent with pretibial myxedema. Myxedematous changes of skin usually occur in pretibial areas and resemble orange peel in color and texture.
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Hypothalamic-pituitary-thyroid axis feedback. Schematic representation of negative feedback system that regulates thyroid hormone levels. TRH = thyrotropin-releasing hormone; TSH = thyroid-stimulating hormone.