Hyperthyroidism
Key Points
Key Points
- Thyrotoxicosis is a condition having multiple etiologies, manifestations, and potential therapies.
- The term "thyrotoxicosis" refers to a clinical state that results from inappropriately high thyroid hormone action in tissues due to inappropriately high tissue thyroid hormone levels.
- The term "hyperthyroidism," as used in these guidelines, is a form of thyrotoxicosis due to inappropriately high synthesis and secretion of thyroid hormone(s) by the thyroid.
- Appropriate treatment of thyrotoxicosis requires an accurate diagnosis.
- For example, thyroidectomy is an appropriate treatment for some forms of thyrotoxicosis and not for others.
- Additionally, β-blockers may be used in almost all forms of thyrotoxicosis, whereas antithyroid drugs (ATDs) are useful in only some.
- In the United States, the prevalence of hyperthyroidism is approximately 1.2% (0.5% overt and 0.7% subclinical).
- The most common causes include Graves' disease (GD), toxic multinodular goiter (TMNG), toxic adenoma (TA) and and painless thyroiditis.
Determination of Etiology
...rmination of Etiol...
...he etiology of thyrotoxicosis should be...
...Causes of ThyrotoxicosisHaving trouble viewing...
Symptomatic Management
Symptomatic Man...
2. β-adrenergic blockade is recommended in al...
...Beta-Adrenergic Receptor Blockade in the Treatmen...
Graves' Disease
...s' Disease...
...al Situations That Favor a Particular Modality as...
...ents with overt Graves' hyperthyroidism...
RA...
...treatment of GD can cause a transie...
.... In addition to β-adrenergic blockade...
6. In patients who are at increase...
...ical therapy of any comorbid condition...
...cient activity of RAI should be administe...
...test should be obtained within 48...
...sician administering RAI should provide writt...
...-up within the first 1–2 months after...
...perthyroidism due to GD persists aft...
...TDs
...mazole (MMI) should be used in virtu...
14. Patients should be informed of side...
...5. Prior to initiating ATD therapy for G...
...ifferential white blood cell count...
...sufficient evidence to recommend for or again...
.... Liver function and hepatocellula...
.... There is insufficient information to recommend...
...inor cutaneous reactions may be managed wi...
...of TRAb levels prior to stopping ATD the...
...chosen as the primary therapy for G...
...tient with GD becomes hyperthyroid after...
Iodine
...ium iodide may be of benefit in select...
...yroidectom...
...surgery is chosen as treatment for GD, pa...
...Calcium and 25-OH-vitamin D should be asse...
27. In exceptional circumstances, when it...
...rgery is chosen as the primary therapy...
...urgery is chosen as the primary therapy for GD,...
...wing thyroidectomy for GD, alternative stra...
...D should be stopped at the time of thyroidect...
...lowing thyroidectomy for GD, L-thyroxine sho...
...Communication among different membe...
...id Nodules in GD...
...yroid nodule is discovered in a patient wi...
Thyroid St...
...s of thyroid storm should be made clinicall...
...6. A multimodality treatment approach to patien...
...Scale for the Diagnosis of Thyroid StormHa...
...ble 5. Thyroid Storm: Drugs and Doses...
...ves' Orbitopath...
...Assessment of GO: Clinical Activity S...
...verity AssessmentHaving trouble viewing table...
...yroidism should be expeditiously ac...
...mmends clinicians advise patients with G...
...n nonsmoking patients with GD witho...
.... In smoking patients with GD without appa...
...is insufficient evidence to recommend for...
...2. In patients with Graves’ hyperthyroidism who...
...In the absence of any strong contrain...
...tients with mild GO who are treated with R...
...with active and moderate to severe or sig...
...ents with inactive GO the ATA suggests...
...ble 8. Use of Oral Glucocorticoids for P...
...e 9. Risk Factors for Graves’ Orbitopa...
...ildren and Adole...
...neral
...ith GD should be treated with MMI, RAI thera...
...a adrenergic blockade is recommended for...
ATD
.... MMI should be used in children who ar...
...atric patients and their caretakers should...
...nitiating ATD therapy, the ATA suggests that pedi...
...ld be stopped immediately, and white blood...
...3. In general, PTU should not be u...
...ent minor cutaneous reactions to MMI t...
...If MMI is chosen as the first-line treatment fo...
...ncer Risk See Table 15)...
...atients with GD who are not in remission fo...
...A suggests that children with GD h...
...RAI therapy is chosen as treatment for GD...
Surge...
.... Children with GD undergoing thyroide...
...urgery is chosen as therapy for GD in childre...
...idectomy in children should be performed...
TMNG or TA
...NG or TA
...ATA suggests that patients with overtly TMNG...
...linical Situations That Favor a Particul...
...AI...
.... Because RAI treatment of TMNG or T...
...n to β-adrenergic blockade (see Recs....
...who are at increased risk for complications d...
...nfunctioning nodules on radionuclid...
...activity of RAI should be administered in a singl...
.... Sufficient activity of RAI should be...
...up within the first 1–2 months after RAI t...
70. If hyperthyroidism persists bey...
...rgery...
...If surgery is chosen as treatment for...
...surgery is chosen as treatment for TMNG, near-to...
...urgery for TMNG should be performed by a hi...
...surgery is chosen as the treatment for TA, a th...
...uggests that surgery for TA be performed by a...
...ing thyroidectomy for TMNG, serum cal...
...I should be stopped at the time of surgery...
...Following thyroidectomy for TMNG, thyro...
...ing lobectomy for TA, TSH and estimate...
...therapy should be used for retreatment of p...
...TDs
...MMI treatment of TMNG or TA might be indicated in...
...ol or Radiofrequency Ab...
...therapies such as ethanol or radiofrequency...
Subclinical Hyperthyroidism and Pregnancy
...Hyperthyroidism and Pregnancy...
...ical Hyperthyroidism (SH)
...n TSH is persistently...
84. When TSH is persistently...
...When TSH is persistently below the lo...
...hen TSH is persistently below the lower limit o...
...o be treated, the treatment should be based o...
...Subclinical Hyperthyroidism: When to TreatHa...
...gnancy
...nosis of hyperthyroidism in pregna...
89. Transient hCG-mediated TSH suppression in...
...rapy should be used for overt hyperthyr...
...women who develop hyperthyroidism during...
...suggests that women with hyperthyroidism...
...Women with hyperthyroidism caused by GD who ar...
...suggests that women who are treated with ATD...
...ggests that a woman who tests positive for pregnan...
...gests that the physician contacted according to...
...ggests that women in early pregnancy...
.... Women taking PTU during the 1st trimester of pr...
...9. GD during pregnancy should be treated w...
...cy is a relative contraindication to thyroid...
...dectomy is necessary for the treatmen...
102. When thyroidectomy is necessa...
...3. Patients who were treated with...
...4. Patients receiving ATD for GD when becom...
.... Patients with elevated TRAb levels at 18–22...
...ostpartum Thyroiditi...
...omen developing thyrotoxicosis after delivery,...
...women with symptomatic thyrotoxicosis from post...
...regnant women diagnosed with hyperthyroidism du...
...ry of Recommendations Concerning Management of G...
Other Conditions
Other Conditio...
...rug-Associated Thyrotoxic...
...13. Causes of Drug-Associated Thyr...
...nts taking medications known to cause thyroto...
...ne-induced Hyperthyroidism...
...ministration of ATDs before iodinated c...
...1. Beta-adrenergic blocking agents alone or in...
...miodarone-induced Thyrotoxicosis (AIT)...
...ATA suggests monitoring thyroid function te...
...ecision to stop amiodarone in the setting of thy...
.... In clinically stable patients with AIT, the ATA...
...d be used to treat overt thyrotoxicosis in...
.... Combined ATD and corticosteroid therapy sho...
...Patients with AIT who are unresponsive to ag...
...1. A Suggested Approach to the Manageme...
...estructive Thyroiditi...
Subacute Thyro...
...with mild symptomatic subacute thyroid...
...nless Thyroiditi...
...19. Patients with symptomatic thyrotox...
...e Thyroiditis...
...oiditis should be treated with antibiotics and s...
...al Causes of Thyrotoxico...
.... Unusual Causes of ThyrotoxicosisHa...
...-Secreting Pituitary Tu...
...The diagnosis of a TSH-secreting pituitar...
...nts with TSH-secreting pituitary adenoma...
...uma Ovarii
...ith struma ovarii should be treate...
...oriocarcinoma
...4. Treatment of hyperthyroidism due...
Appendix
Appendi...
...ble 15. Theoretical Projections of Cancer Incidenc...