Last reviewed: 29 Oct 2020
Last updated: 18 Feb 2020

Summary

Definition

History and exam

Key diagnostic factors

  • heat intolerance
  • nervousness
  • small non-tender goitre
  • tremulousness

Other diagnostic factors

  • palpitations
  • weight loss
  • excessive fatigue
  • bloating
  • muscle cramps
  • weight gain
  • poor concentration
  • cold intolerance
  • tachycardia

Risk factors

  • postnatal period
  • female sex
  • thyroid peroxidase (TPO) antibodies
  • immuno-modulatory therapy
  • lithium therapy
  • type 1 diabetes and other autoimmune conditions
  • autoimmune family history

Diagnostic investigations

1st investigations to order

  • thyroid-stimulating hormone (TSH)
  • serum free T4 and T3
  • thyroid peroxidase (TPO) antibodies
  • TSH-receptor antibodies (TRAb)
  • 4-, 6-, or 24-hour radioiodine uptake
  • total T3/T4 ratio
More 1st investigations to order

Investigations to consider

  • technetium-99m pertechnetate scan
  • serum thyroglobulin
  • thyroid biopsy
More investigations to consider

Treatment algorithm

Contributors

Consultant

Department of Endocrinology

Newcastle upon Tyne Hospitals NHS Foundation Trust

Newcastle upon Tyne

UK

Disclosures

PP has been an invited speaker on thyroid topics for the British Endocrine Societies, the American Association of Clinical Endocrinologists Gulf Chapter, Lebanese Society of Endocrinology Diabetes and Lipids, Emirates Thyroid Congress, Cyprus Endocrine Society, European Group On Graves Orbitopathy, European Thyroid Association and Azerbaijan State Advanced Training Institute for Doctors. He has received honoraria for speaking at meetings organised by the American Association of Clinical Endocrinologists Gulf Chapter, the Lebanese Society of Endocrinology Diabetes and Lipids and Azerbaijan State Advanced Training Institute for Doctors and has done consultancy work for IBSA Institut Biochemie SA.

Dr Petros Perros would like to gratefully acknowledge Dr Douglas S. Ross, the previous contributor to this monograph. DSR declares that he has no competing interests.

Peer reviewersVIEW ALL

Centre for Endocrine and Diabetes Sciences

Cardiff University School of Medicine

University Hospital of Wales

Heath Park

Cardiff

UK

Disclosures

JL declares that he has no competing interests.

Professor of Surgery

Virginia Commonwealth University

Richmond

VA

Disclosures

RM declares that he has no competing interests.

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