Summary
Definition
History and exam
Key diagnostic factors
- family history of autoimmune thyroid disease
- history of tobacco use
- heat intolerance
- sweating
- weight loss
- palpitations
- tremor
- diffuse goiter
- orbitopathy
Other diagnostic factors
- irritability
- cardiac flow murmur
- moist, velvety skin
- scalp hair loss
- sexual dysfunction
- muscle weakness
- thyroid bruit
- onycholysis
- vitiligo
- pretibial myxedema
- acropachy
- menstrual irregularity
Risk factors
- family history autoimmune thyroid disease
- female gender
- tobacco use
- high iodine intake
- use of lithium
- use of certain biologic agents and cytokine therapies
- radiation
- use of radioiodine therapy for benign nodular goiter
- stress
Diagnostic tests
1st tests to order
- thyroid-stimulating hormone (TSH)
- serum free or total T4
- serum free or total T3
- TSH receptor antibodies (TRAb)
Tests to consider
- calculation of total T3/T4 or FT3/FT4 ratio
- radioactive iodine or technetium-99 uptake
- thyroid scan (scintigraphy)
- thyroid peroxidase antibodies (TPOAb)
- thyroid ultrasound
- CT or MRI scan of orbit
- skin biopsy
Treatment algorithm
thyroid storm
subclinical Graves disease
symptomatic nonpregnant, nonlactating 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
Declarações
SR has received speaker fees from Merck KGaA, IBSA, and Berlin Chemie, manufacturers of thyroid hormones.
Agradecimentos
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.
Declarações
PP, DSR, GH, and VF are authors of references cited in this topic.
Revisores
Tae-Hwa Chun, MD PhD
Associate Professor of Internal Medicine (Endocrinology)
University of Michigan
Ann Arbor, MI
Declarações
THC declares that he has no competing interests.
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
Declarações
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
Declarações
PC declares that he has no competing interests.
Créditos aos pareceristas
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As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016 Oct;26(10):1343-421.Texto completo Resumo
Kahaly GJ, Bartalena L, Hegedüs L, et al. 2018 European Thyroid Association guideline for the management of Graves' hyperthyroidism. Eur Thyroid J. 2018 Jul 25;7(4):167-86.Texto completo Resumo
National Institute for Health and Care Excellence. Thyroid disease: assessment and management. Oct 2023 [internet publication].Texto completo
Mooij CF, Cheetham TD, Verburg FA, et al. 2022 European Thyroid Association guideline for the management of pediatric Graves' disease. Eur Thyroid J. 2022 Jan 1;11(1):e210073.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Toxic nodular goiter
- Painless and postpartum thyroiditis
- Gestational hyperthyroidism
Mais Diagnósticos diferenciaisDiretrizes
- Practice parameter for treatment of benign and malignant thyroid disease with I-131 sodium iodide
- The EANM guideline on radioiodine therapy of benign thyroid disease
Mais DiretrizesFolhetos informativos para os pacientes
Graves disease
Mais Folhetos informativos para os pacientes
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