Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis

Publication Date: October 1, 2016
Last Updated: October 16, 2023

Determination of Etiology

1. The etiology of thyrotoxicosis should be determined. If the diagnosis is not apparent based on the clinical presentation and initial biochemical evaluation, diagnostic testing is indicated and can include, depending on available expertise and resources:
  1. measurement of thyrotropin receptor antibodies (TRAb)
  2. determination of the radioactive iodine uptake (RAIU) or
  3. measurement of thyroidal blood flow on ultrasonography.
    • An 123I or 99mTc pertechnetate scan should be obtained when the clinical presentation suggests a toxic adenoma or toxic multinodular goiter.
( S , M )
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Symptomatic Management

2. β-adrenergic blockade is recommended in all patients with symptomatic thyrotoxicosis, especially elderly patients and thyrotoxic patients with resting heart rates >90 bpm or coexistent cardiovascular disease. ( S , M )
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Graves' Disease

3. Patients with overt Graves' hyperthyroidism should be treated with any of the following modalities: Radioactive iodine (RAI) therapy, antithyroid drugs (ATDs), or thyroidectomy. ( S , M )
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Overview

Title

Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis

Authoring Organization

American Thyroid Association