Most common in older patients.
Onset of symptoms is more insidious and symptoms less dramatic than for Graves disease. Patients may have apathetic hyperthyroidism (minimal signs/symptoms) or subclinical hyperthyroidism (isolated thyroid-stimulating hormone suppression).
Spontaneous remission is rare. Definitive treatment, most commonly radioactive iodine, is usually required.
If untreated, complications may include sequelae of hyperthyroidism, such as cardiac dysfunction or bone loss, or tracheal compression by large goiters.
A toxic multinodular goiter (MNG; also known as Plummer disease) contains multiple autonomously functioning nodules, resulting in hyperthyroidism. These nodules function independently of thyroid-stimulating hormone and are almost always benign. However, nonfunctioning thyroid nodules in the same goiter may be malignant.
History and exam
- 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
- thyroid peroxidase antibodies
- TSH receptor antibodies
- CT neck (noncontrast)
Professor of Medicine
Boston University Medical Center
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.
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