When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Toxic thyroid adenoma

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Evidence last reviewed: 19 Jun 2026
Topic last updated: 17 Jul 2026

Summary

Definition

History and exam

Key diagnostic factors

  • palpable thyroid nodule
  • younger age
Full details

Other diagnostic factors

  • hyperphagia
  • weight loss
  • sweating/heat intolerance
  • nervousness
  • palpitations
  • oligomenorrhea
  • hyperdefecation
  • dyspnea
  • stare or lid lag
  • tachycardia
  • tremor
  • warm moist skin
  • muscle weakness
  • hoarseness
  • dysphagia
  • choking
  • mood change
Full details

Risk factors

  • younger age
  • iodine deficiency
  • head and neck irradiation
  • family history of thyroid nodules
  • female sex
Full details

Diagnostic tests

1st tests to order

  • thyroid stimulating hormone (TSH)
Full details

Tests to consider

  • free thyroxine (T4; or total T4 with a measure of binding)
  • total triiodothyronine (T3) with a measure of binding (or free T3)
  • thyroid scan and uptake (scintigraphy)
  • thyroid ultrasound
  • metabolic panel
  • CBC
  • TSH receptor antibodies
  • thyroid peroxidase antibodies
  • ECG
  • CT neck (noncontrast)
Full details

Treatment algorithm

ONGOING

nonpregnant nonlactating adults without mass effect

nonpregnant nonlactating adults with mass effect

pregnant or lactating

Contributors

Authors

Elizabeth N. Pearce, MD

Professor of Medicine

Boston University Medical Center

Boston, MA

Disclosures

ENP is a member of the Management Council of the Iodine Global Network. She has received honoraria and travel support for lectures at the Merck China Symposium. She has received honoraria and travel support for lectures about iodine nutrition from the National Dairy Council. She is a Deputy Editor at the Journal of Clinical Endocrinology and Metabolism. She is a member of the thyroid in pregnancy guidelines revision task force for the American Thyroid Association. She is a member of the World Health Organization's iodine guidelines advisory panel.

Acknowledgements

Dr Elizabeth N. Pearce would like to gratefully acknowledge Dr Sheila Feit, the previous contributor to this topic.

Peer reviewers

John C. Morris, MD

Professor of Medicine

Mayo Clinic

Rochester, MN

Disclosures

JCM declares that he has no competing interests.

Petros Perros, BSc, MBBS, MD, FRCP

Consultant Endocrinologist

Freeman Hospital

Newcastle-Upon-Tyne

UK

Disclosures

PP declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

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.Full text  Abstract

Chaker L, Cooper DS, Walsh JP, et al. Hyperthyroidism. Lancet. 2024 Feb 24;403(10428):768-80. Abstract

Gharib H, Papini E, Garber JR, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules - 2016 update. Endocr Pract. 2016 May;22(5):622-39.Full text  Abstract

National Institute for Health and Care Excellence. Thyroid disease: assessment and management. Oct 2023 [internet publication].Full text

Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016 Jan;26(1):1-133.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Toxic thyroid adenoma images

  • Differentials

    • Graves disease
    • Toxic multinodular goiter
    • Thyrotoxic phase of painless lymphocytic thyroiditis
    More Differentials

  • Guidelines

    • ACR–ACNM–ARS–SNMMI–SPR practice parameter for treatment of benign and malignant thyroid disease with I-131 sodium iodide
    • American Association of Clinical Endocrinology and Associazione Medici Endocrinologi thyroid nodule algorithmic tool
    More Guidelines
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer