Resumo
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- intolerância ao calor
- sudorese
- perda de peso
- palpitações
- tremor
- bócio difuso
- orbitopatia
Other diagnostic factors
- irritabilidade
- sopro cardíaco
- pele úmida e aveludada
- queda de cabelos
- fraqueza muscular
- sopro tireoidiano
- onicólise
- vitiligo
- mixedema pré-tibial
- acropaquia
- irregularidade menstrual
- disfunção sexual
Risk factors
- história familiar de doença tireoidiana autoimune
- sexo feminino
- tabagismo
- ingestão elevada de iodo
- terapia com lítio
- agente biológico e terapias com citocina
- radiação
- radioterapia com iodo para bócio nodular benigno
- estresse
Diagnostic tests
1st tests to order
- hormônio estimulante da tireoide (TSH)
- T4 sérico livre ou total
- T3 total ou livre sérico
- anticorpos antirreceptor de hormônio estimulante da tireoide (TSH [TRAb])
Tests to consider
- cálculo da razão T3/T4 ou T3L/T4L total
- captação de iodo radioativo ou tecnécio-99
- cintilografia da tireoide
- anticorpos antitireoperoxidase (TPOAb)
- ultrassonografia da tireoide
- tomografia computadorizada (TC) ou ressonância nuclear magnética (RNM) da órbita
- biópsia de pele
Treatment algorithm
tempestade tireoidiana
doença de Graves subclínica
adultos sintomáticos não lactantes e não gestantes
gestantes
crianças
Contributors
Authors
Salman Razvi, MD
Consultant Endocrinologist and Senior Lecturer
Translational and Clinical Research Institute, Queen Elizabeth Hospital, Gateshead
Newcastle University
Newcastle upon Tyne
UK
Disclosures
SR has received speaker fees from Merck, IBSA, and Abbott Pharmaceuticals Ltd., all makers of levothyroxine. In addition, SR is in receipt of funding for an investigator-initiated trial from Merck to study the role of thyroid hormones in heart failure.
Acknowledgements
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.
Disclosures
PP, DSR, GH, and VF are authors of references cited in this topic.
Peer reviewers
Elizabeth N. Pearce, MD
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.
Kristien Boelaert, MD, PhD, FRCP
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.
Paul Carroll, MD, FRCP
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.
David Cooper, MD
Division Head
Endocrinology
Sinai Hospital of Baltimore
Baltimore
MD
Disclosures
DC declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Kahaly GJ, Bartalena L, Hegedüs L, et al. 2018 European Thyroid Association guideline for the management of Graves' hyperthyroidism. Eur Thyroid J. 2018 Jul 25;7(4):167-86.Full text Abstract
Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016 Oct;26(10):1343-421.Full text Abstract
National Institute for Health and Care Excellence. Thyroid disease: assessment and management. Oct 2023 [internet publication].Full text
Mooij CF, Cheetham TD, Verburg FA, et al. 2022 European Thyroid Association guideline for the management of pediatric Graves' disease. Eur Thyroid J. 2022 Jan 1;11(1):e210073.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Bócio nodular tóxico
- Tireoidite indolor e pós-parto
- Hipertireoidismo gestacional
More DifferentialsGuidelines
- Thyroid disease in pregnancy
- Practice parameter for treatment of benign and malignant thyroid disease with I-131 sodium iodide
More GuidelinesPatient information
Doença de Graves
More Patient information
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