Summary
Definition
History and exam
Key diagnostic factors
- palpable thyroid nodule
- younger age
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
Risk factors
- young adult age
- iodine deficiency
- head and neck irradiation
- family history of thyroid nodules
- female sex
Diagnostic tests
1st tests to order
- thyroid stimulating hormone (TSH)
Tests 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
- thyroid ultrasound
- metabolic panel
- CBC
- TSH receptor antibodies
- thyroid peroxidase antibodies
- ECG
- CT neck (noncontrast)
Treatment algorithm
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 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.
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.
References
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
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
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.
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