Toxic thyroid adenoma

Last reviewed: 7 Jan 2023
Last updated: 17 Jun 2022



History and exam

Key diagnostic factors

  • presence of risk factors
  • palpable thyroid nodule
  • younger age
More key diagnostic factors

Other diagnostic factors

  • hyperphagia
  • weight loss
  • sweating/heat intolerance
  • nervousness
  • palpitations
  • oligomenorrhoea
  • hyperdefecation
  • dyspnoea
  • stare or lid lag
  • tachycardia
  • tremor
  • warm moist skin
  • muscle weakness
  • hoarseness
  • dysphagia
  • choking
  • mood change
Other diagnostic factors

Risk factors

  • young adult age
  • iodine deficiency
  • head and neck irradiation
  • family history of thyroid nodules
  • female sex
More risk factors

Diagnostic investigations

1st investigations to order

  • thyroid stimulating hormone (TSH)
  • thyroid ultrasound
More 1st investigations to order

Investigations to consider

  • free thyroxine (T4; or total T4 with a measure of binding)
  • total T3 with a measure of binding (or free T3)
  • thyroid scan and uptake
  • metabolic panel
  • FBC
  • TSH receptor antibodies
  • thyroid peroxidase antibodies
  • ECG
  • CT neck (non-contrast)
More investigations to consider

Treatment algorithm


non-pregnant non-lactating adults without mass effect

non-pregnant non-lactating adults with mass effect

pregnant or lactating



Elizabeth N. Pearce, MD

Professor of Medicine

Boston University Medical Center




ENP is a member of the Management Council of the Iodine Global Network. She was the 2018-2019 President of the American Thyroid Association (ATA) and served on its board and executive committee until 2020. She is a current member of the ATA's thyroid in pregnancy guidelines writing task force. She is currently a Deputy Editor at the Journal of Clinical Endocrinology and Metabolism and has previously served as an Associated Editor for the journals Thyroid, Endocrine Practice, and Clinical Thyroidology. She is an author of a number of references cited in this topic.


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




JCM declares that he has no competing interests.

Petros Perros, BSc, MBBS, MD, FRCP

Consultant Endocrinologist

Freeman Hospital




PP declares that he has no competing interests.

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