Last reviewed: June 2020
Last updated: February
2019
Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- palpable thyroid nodule
- younger age
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
Risk factors
- young adult age
- iodine deficiency
- head and neck irradiation
- family history of thyroid nodules
- female sex
Diagnostic investigations
1st investigations to order
- thyroid stimulating hormone (TSH)
- thyroid ultrasound
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)
Treatment algorithm
Contributors
Authors
Associate Professor of Medicine
Boston University Medical Center
Boston
MA
Disclosures
ENP has received honoraria and travel funding for speaking at two international conferences for Merck Serono and at one for IBSA. She is a member of the Management Council of the Iodine Global Network. 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
Professor of Medicine
Mayo Clinic
Rochester
MN
Disclosures
JCM declares that he has no competing interests.
Consultant Endocrinologist
Freeman Hospital
Newcastle-Upon-Tyne
UK
Disclosures
PP declares that he has no competing interests.
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