Last reviewed:September 2019
Last updated:September  2019

Summary

Definition

History and exam

Other diagnostic factors

  • heat intolerance, hyperphagia, or weight loss
  • depression
  • nervousness or palpitations
  • oligomenorrhea
  • hyperdefecation
  • stare or lid lag
  • warm, moist skin
  • tachycardia
  • irregular pulse
  • tremor
  • muscle weakness
  • shortness of breath¬†or choking sensation
  • Pemberton sign

Risk factors

  • iodine deficiency
  • age >40 years
  • head and neck irradiation
  • family history of¬†thyroid nodules
  • female sex

Diagnostic investigations

1st investigations to order

  • thyroid-stimulating hormone (TSH)
Full details

Investigations to consider

  • free T4 (or total T4 with a measure of binding)
  • total T3 with a measure of binding (or free T3)
  • I-123 thyroid scan and uptake
  • Tc-99 pertechnetate scan
  • thyroid ultrasound
  • metabolic panel
  • CBC
  • thyroid peroxidase antibodies
  • TSH receptor antibodies
  • ECG
  • CT neck (noncontrast)
Full details

Treatment algorithm

Contributors

Professor of Medicine

Boston University Medical Center

Boston

MA

Disclosures

ENP is the 2018-2019 President of the American Thyroid Association. 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, a previous contributor to this topic. SF was previously employed by BMJ.

Peer reviewersVIEW ALL

Consultant Endocrinologist

Freeman Hospital

Newcastle-Upon-Tyne

UK

Disclosures

PP 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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