Last reviewed: February 2018
Last updated: October  2017



History and exam

Key diagnostic factors

  • presence of risk factors
  • goitre

Other diagnostic factors

  • heat intolerance, hyperphagia, or weight loss
  • depression
  • nervousness or palpitations
  • oligomenorrhoea
  • hyperdefecation
  • stare or lid lag
  • warm, moist skin
  • tachycardia
  • irregular pulse
  • tremor
  • muscle weakness
  • SOB or choking sensation
  • Pemberton's sign

Risk factors

  • iodine deficiency
  • age >40 years
  • head and neck irradiation
  • FHx thyroid nodules
  • female gender

Diagnostic investigations

1st investigations to order

  • thyroid-stimulating hormone (TSH)
Full details

Investigations to consider

  • free T4 (or total T4 with measure of binding)
  • total T3 with a measure of binding (or free T3)
  • I-123 thyroid scan and uptake
  • Tc-99 pertechnetate scan
  • thyroid ultrasound
  • metabolic panel
  • FBC
  • thyroid peroxidase antibodies
  • TSH receptor 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, a previous contributor to this monograph. SF is an employee of the BMJ Group.

Peer reviewers VIEW ALL

Consultant Endocrinologist

Freeman Hospital




PP declares that he has no competing interests.

Professor of Surgery

Virginia Commonwealth University




RM declares that he has no competing interests.

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