Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • FHx autoimmune thyroid disease
  • hx of tobacco use
  • heat intolerance
  • sweating
  • weight loss
  • palpitations
  • tremor
  • tachycardia
  • diffuse goiter
  • orbitopathy

Other diagnostic factors

  • irritability
  • wide pulse pressure
  • cardiac flow murmur
  • moist, velvety skin
  • scalp hair loss
  • thyroid bruit
  • onycholysis
  • vitiligo
  • pretibial myxedema
  • acropachy

Risk factors

  • FHx autoimmune thyroid disease
  • female sex
  • tobacco use
  • high iodine intake
  • lithium therapy
  • biologic agent and cytokine therapies
  • radiation
  • radioiodine therapy for benign nodular goiter
  • stress

Diagnostic investigations

1st investigations to order

  • TSH
  • serum free T4
  • serum free or total T3
  • T3RU, free T4 index
  • calculation of total T3/T4 or FT3/FT4 ratio
Full details

Investigations to consider

  • radioactive iodine (I-131 or I-123) or technetium-99 (Tc-99) uptake
  • thyroid isotope scan
  • TSH receptor antibodies (TRAb)
  • thyroid ultrasound
  • CT or MRI scan of orbit
  • skin biopsy
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Consultant

Department of Endocrinology

Newcastle upon Tyne Hospitals NHS Foundation Trust

Newcastle upon Tyne

UK

Disclosures

PP has carried out unpaid work for the following organisations: British Thyroid Foundation, British Thyroid Association, Society for Endocrinology (Thyroid Network), Butterfly Thyroid Cancer Trust, Hypopara UK, Thyroid Federation International, Thyroid Eye Disease Amsterdam Declaration Implementation, and European Group on Graves' Orbitopathy. PP is an author of a number of references cited in this monograph.

Dr Petros Perros would like to gratefully acknowledge Dr Douglas S. Ross, Dr George Hennemann, and Dr Vahab Fatourechi, the previous contributors to this monograph.

Disclosures

DSR, GH, and VF are authors of a number of references cited in this monograph.

Peer reviewers VIEW ALL

Associate Professor of Medicine

Boston University Medical Center

Boston

MA

Disclosures

ENP is a consultant for Scientific Consulting Company GmbH and a management council member for the Iodine Global Network.

Reader in Endocrinology

Institute of Metabolism and Systems Research

College of Medical and Dental Sciences

University of Birmingham

Birmingham

UK

Disclosures

KB declares that she has no competing interests.

Clinical Lead for Endocrinology

Chair of Thyroid MDM

Guy’s and St Thomas’ NHS Trust

London

UK

Disclosures

PC declares that he has no competing interests.

Division Head

Endocrinology

Sinai Hospital of Baltimore

Baltimore

MD

Disclosures

DC declares that he has no competing interests.

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