Last reviewed: February 2018
Last updated: June  2017



History and exam

Key diagnostic factors

  • presence of risk factors
  • palpable thyroid nodule
  • younger age

Other diagnostic factors

  • hyperphagia
  • weight loss
  • sweating/heat intolerance
  • nervousness
  • palpitations
  • oligomenorrhoea
  • hyperdefecation
  • dyspnoea
  • stare or lid lag
  • tachycardia
  • tremor
  • warm moist skin
  • muscle weakness
  • hoarseness
  • dysphagia
  • choking
  • mood change

Risk factors

  • young adult age
  • iodine deficiency
  • head and neck irradiation
  • Fhx of thyroid nodules
  • female gender

Diagnostic investigations

1st investigations to order

  • TSH
  • thyroid ultrasound
Full details

Investigations to consider

  • free T4 (or total T4 with a measure of binding)
  • total T3 with a measure of binding (or free T3)
  • thyroid scan and uptake
  • metabolic panel
  • FBC
  • TSH receptor antibodies
  • thyroid peroxidase antibodies
  • ECG
  • CT neck (non-contrast)
Full details

Treatment algorithm


Authors VIEW ALL

Associate Professor of Medicine

Boston University Medical Center




ENP has received honoraria and travel funding for speaking at two international conferences for Merck Serono and at one for IBSA. She is a member of the Management Council of the Iodine Global Network. She is an author of a number of references cited in this monograph.

Dr Elizabeth N. Pearce would like to gratefully acknowledge Dr Sheila Feit, the previous contributor to this monograph. SF is an employee of the BMJ Group.

Peer reviewers VIEW ALL

Professor of Medicine

Mayo Clinic




JCM declares that he has no competing interests.

Consultant Endocrinologist

Freeman Hospital




PP declares that he has no competing interests.

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