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
- lithium therapy
- biologic agent and cytokine therapies
- radiation
- radioiodine therapy for benign nodular goiter
- 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 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, IBSA and Abbott Pharmaceuticals Ltd and research funding from Merck.
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
Elizabeth N. Pearce, MD
Associate Professor of Medicine
Boston University Medical Center
Boston
MA
Declarações
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
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.
David Cooper, MD
Division Head
Endocrinology
Sinai Hospital of Baltimore
Baltimore
MD
Declarações
DC declares that he has no competing interests.
Diagnósticos diferenciais
- Toxic nodular goiter
- Painless and postpartum thyroiditis
- Gestational hyperthyroidism
Mais Diagnósticos diferenciaisDiretrizes
- Management of thyroid eye disease: a consensus statement by the American Thyroid Association and the European Thyroid Association
- Management of pediatric Graves' disease
Mais DiretrizesFolhetos informativos para os pacientes
Graves disease
Mais Folhetos informativos para os pacientesConectar-se ou assinar para acessar todo o BMJ Best Practice
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