Summary
Definition
History and exam
Key diagnostic factors
- heat intolerance
- nervousness
- small nontender goiter
- tremulousness
Other diagnostic factors
- palpitations
- weight loss
- excessive fatigue
- bloating
- muscle cramps
- weight gain
- poor concentration
- cold intolerance
- tachycardia
Risk factors
- postpartum period
- female sex
- thyroid peroxidase (TPO) antibodies
- imunnomodulatory 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
- TPO (thyroid peroxidase) antibodies
- TSH-receptor antibodies (TRAb)
- 4-, 6-, or 24-hour radioiodine uptake
- total T3/T4 ratio
Investigations to consider
- technetium-99m pertechnetate scan
- serum thyroglobulin
- thyroid biopsy
Emerging tests
- color-flow Doppler
Treatment algorithm
thyrotoxic phase: mild
thyrotoxic phase: moderate
thyrotoxic phase: severe
hypothyroid phase: mild
hypothyroid phase: moderate to severe
recurrent thyroiditis
Contributors
Authors
Petros Perros, MD
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.
Acknowledgements
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 reviewers
John Lazarus, MA, MD, FRCP, FACE, FRCOG
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.
Ronald Merrell, MD
Professor of Surgery
Virginia Commonwealth University
Richmond
VA
Disclosures
RM declares that he has no competing interests.
Differentials
- Hashimoto (chronic lymphocytic) thyroiditis
- Graves disease
- Toxic multinodular goiter
More DifferentialsGuidelines
- ACR practice parameter for the performance of therapy with unsealed radiopharmaceutical sources
- 2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum
More GuidelinesPatient leaflets
Underactive thyroid
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