Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- heat intolerance
- sweating
- weight loss
- palpitations
- tremor
- diffuse goitre
- orbitopathy
Other diagnostic factors
- irritability
- cardiac flow murmur
- moist, velvety skin
- scalp hair loss
- muscle weakness
- thyroid bruit
- onycholysis
- vitiligo
- pretibial myxoedema
- acropachy
- menstrual irregularity
- sexual dysfunction
Risk factors
- family history autoimmune thyroid disease
- female sex
- tobacco use
- high iodine intake
- lithium therapy
- biological agent and cytokine therapies
- radiation
- radioiodine therapy for benign nodular goitre
- stress
Diagnostic investigations
1st investigations to order
- TSH
- TSH receptor antibodies (TRAb)
- serum free or total T4
- serum free or total T3
Investigations to consider
- calculation of total T3/T4 or FT3/FT4 ratio
- radioactive iodine (I-131 or I-123) or technetium-99 (Tc-99) uptake
- thyroid isotope scan
- thyroid peroxidase antibodies (TPOAb)
- thyroid ultrasound
- CT or MRI scan of orbit
- skin biopsy
Treatment algorithm
thyroid storm
subclinical Graves' disease
symptomatic non-pregnant, non-lactating adults
pregnant women
children
Contributors
Authors
Salman Razvi, MD
Consultant Endocrinologist and Senior Lecturer
Translational and Clinical Research Institute, Queen Elizabeth Hospital, Gateshead
Newcastle University
Newcastle upon Tyne
UK
Disclosures
SR declares that he has no competing interests.
Acknowledgements
Dr Salman Razvi would like to gratefully acknowledge Dr Petros Perros, Dr Douglas S. Ross, Dr George Hennemann, and Dr Vahab Fatourechi, previous contributors to this topic.
Disclosures
PP, DSR, GH, and VF are authors of references cited in this topic.
Peer reviewers
Elizabeth N. Pearce, MD
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.
Kristien Boelaert, MD, PhD, FRCP
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.
Paul Carroll, MD, FRCP
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.
David Cooper, MD
Division Head
Endocrinology
Sinai Hospital of Baltimore
Baltimore
MD
Disclosures
DC declares that he has no competing interests.
Differentials
- Toxic nodular goitre
- Painless and postnatal thyroiditis
- Gestational hyperthyroidism
More DifferentialsGuidelines
- Management of pediatric Graves' disease
- Guidelines for the management of Graves' orbitopathy
More GuidelinesPatient leaflets
Graves’ disease
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