Last reviewed: June 2020
Last updated: May  2020

Summary

Definition

History and exam

Key diagnostic factors

  • family history of autoimmune thyroid disease
  • history of tobacco use
  • heat intolerance
  • sweating
  • weight loss
  • palpitations
  • tremor
  • diffuse goiter
  • orbitopathy

Other diagnostic factors

  • irritability
  • cardiac flow murmur
  • moist, velvety skin
  • scalp hair loss
  • sexual dysfunction
  • muscle weakness
  • thyroid bruit
  • onycholysis
  • vitiligo
  • pretibial myxedema
  • acropachy
  • menstrual irregularity

Risk factors

  • family history autoimmune thyroid disease
  • female gender
  • tobacco use
  • high iodine intake
  • lithium therapy
  • biologic agent and cytokine therapies
  • radiation
  • radioiodine therapy for benign nodular goiter
  • stress

Diagnostic investigations

1st investigations to order

  • TSH
  • serum free or total T4
  • serum free or total T3
  • calculation of total T3/T4 or FT3/FT4 ratio
More 1st investigations to order

Investigations to consider

  • T3 resin uptake (T3RU), free T4 index
  • radioactive iodine (I-131 or I-123) or technetium-99 (Tc-99) uptake
  • thyroid isotope scan
  • TSH receptor antibodies (TRAb)
  • thyroid ultrasound
  • CT or MRI scan of orbit
  • skin biopsy
More investigations to consider

Treatment algorithm

Contributors

Consultant Endocrinologist and Honorary Senior Lecturer

Institute of Genetic Medicine and Queen Elizabeth Hospital, Gateshead

Newcastle University

Newcastle upon Tyne

UK

Disclosures

SR has received speaker fees from Merck plc and Abbott India Pharmaceuticals Ltd, the makers of levothyroxine.

Dr Salman Razvi would like to gratefully acknowledge Dr Petros Perros, Dr Douglas S. Ross, Dr George Hennemann, and Dr Vahab Fatourechi, previous contributors to this topic.

Peer reviewersVIEW ALL

Associate Professor of Medicine

Boston University Medical Center

Boston

MA

Disclosures

ENP is a consultant for Scientific Consulting Company GmbH and a management council member for the Iodine Global Network.

Reader in Endocrinology

Institute of Metabolism and Systems Research

College of Medical and Dental Sciences

University of Birmingham

Birmingham

UK

Disclosures

KB declares that she has no competing interests.

Clinical Lead for Endocrinology

Chair of Thyroid MDM

Guy’s and St Thomas’ NHS Trust

London

UK

Disclosures

PC declares that he has no competing interests.

Division Head

Endocrinology

Sinai Hospital of Baltimore

Baltimore

MD

Disclosures

DC declares that he has no competing interests.

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