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
- serum free or total T4
- serum free or total T3
- calculation of total T3/T4 or FT3/FT4 ratio
Investigations to consider
- T3 resin uptake (T3RU), free T4 index
- 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
Treatment algorithm
Contributors
Authors
Consultant Endocrinologist and Honorary Senior Lecturer
Institute of Genetic Medicine and Queen Elizabeth Hospital, Gateshead
Newcastle University
Newcastle upon Tyne
UK
Disclosures
SR has received speaker fees from Merck plc and Abbott India Pharmaceuticals Ltd, the makers of levothyroxine.
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
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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