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
...mination of Etiol...
...y of thyrotoxicosis should be deter...
...s of ThyrotoxicosisHaving trouble viewing ta...
Symptomatic Management
...atic Management...
...rgic blockade is recommended in all patients w...
...Adrenergic Receptor Blockade in the T...
Graves' Disease
...' Disease...
...le 3. Clinical Situations That Favor a Pa...
.... Patients with overt Graves' hyperthyroidism s...
RAI
...Because RAI treatment of GD can cause a tr...
...n to β-adrenergic blockade (see Recs. 2 & 4),...
...patients who are at increased risk for com...
7. Medical therapy of any comorbid c...
.... Sufficient activity of RAI should...
.... A pregnancy test should be obtained within...
...he physician administering RAI should prov...
...ollow-up within the first 1–2 months...
...hyperthyroidism due to GD persists...
ATDs
...(MMI) should be used in virtually every patient wh...
...ients should be informed of side effects of...
...Prior to initiating ATD therapy for GD,...
.... A differential white blood cell c...
...ufficient evidence to recommend for or a...
...function and hepatocellular integrity should b...
...ufficient information to recommend for or...
...aneous reactions may be managed with concur...
...1. Measurement of TRAb levels prior to stopp...
...chosen as the primary therapy for GD, the medicat...
...f a patient with GD becomes hyperthyroid after...
Iodi...
...4. Potassium iodide may be of benefit in select pa...
...oidectomy...
...urgery is chosen as treatment for...
...cium and 25-OH-vitamin D should be assessed...
...7. In exceptional circumstances, w...
...ery is chosen as the primary therapy for...
...is chosen as the primary therapy for GD...
...Following thyroidectomy for GD, alterna...
...e stopped at the time of thyroidectomy for GD, a...
...wing thyroidectomy for GD, L-thyroxi...
...cation among different members of the multidis...
...d Nodules in GD...
34. If a thyroid nodule is discovered in a p...
...oid Storm...
.... The diagnosis of thyroid storm should be made cl...
...ltimodality treatment approach to pati...
...Scale for the Diagnosis of Thyroid StormHaving tr...
...le 5. Thyroid Storm: Drugs and DosesH...
...#39; Orbitopathy (GO)
...ent of GO: Clinical Activity Score Ele...
...7. GO Severity AssessmentHaving trouble viewing t...
...m should be expeditiously achieved...
...ATA recommends clinicians advise patients with...
...smoking patients with GD without apparent...
...ing patients with GD without appare...
...There is insufficient evidence to re...
...atients with Graves’ hyperthyroidism who...
...e absence of any strong contraindication to G...
...GD patients with mild GO who are treate...
...ts with active and moderate to severe...
46. In patients with inactive GO the ATA suggest...
...8. Use of Oral Glucocorticoids for Pr...
.... Risk Factors for Graves’ Orbitop...
...dren and Adolescents
...enera...
...Children with GD should be treated with...
...Beta adrenergic blockade is recommen...
AT...
...MMI should be used in children who a...
...ic patients and their caretakers should be...
...to initiating ATD therapy, the ATA suggests t...
...TDs should be stopped immediately, and white...
...n general, PTU should not be used in children. But...
...istent minor cutaneous reactions to MMI ther...
...f MMI is chosen as the first-line tre...
...AI (For Cancer Risk See Table 1...
...iatric patients with GD who are not in remissio...
...uggests that children with GD havin...
...8. If RAI therapy is chosen as treat...
Surgery
...n with GD undergoing thyroidectomy should be ren...
...If surgery is chosen as therapy for GD in childre...
...omy in children should be performed by high-volum...
TMNG or TA
...MNG or TA
...The ATA suggests that patients with over...
...al Situations That Favor a Particular Modality...
RAI
...Because RAI treatment of TMNG or T...
...addition to β-adrenergic blockade (see Recs...
...tients who are at increased risk f...
...unctioning nodules on radionuclide scintigraphy...
...cient activity of RAI should be admi...
...activity of RAI should be administered i...
...up within the first 1–2 months aft...
70. If hyperthyroidism persists beyond 6 mon...
...urgery
...gery is chosen as treatment for TMNG...
...y is chosen as treatment for TMNG, ne...
...ery for TMNG should be performed by...
...surgery is chosen as the treatment for TA, a t...
.... The ATA suggests that surgery for...
.... Following thyroidectomy for TMNG, se...
...ld be stopped at the time of surgery fo...
...g thyroidectomy for TMNG, thyroid hormone replacem...
...lobectomy for TA, TSH and estimated free T4 le...
...0. RAI therapy should be used for retreatment of...
ATD...
...MMI treatment of TMNG or TA might be in...
...hanol or Radiofrequency A...
...ernative therapies such as ethanol o...
Subclinical Hyperthyroidism and Pregnancy
...Hyperthyroidism and Pregnancy...
...nical Hyperthyroidism (SH)...
...n TSH is persistently...
...n TSH is persistently...
...persistently below the lower limit...
...6. When TSH is persistently below t...
...s to be treated, the treatment should...
...11. Subclinical Hyperthyroidism: When...
...egnancy
...diagnosis of hyperthyroidism in pregn...
...ransient hCG-mediated TSH suppression i...
...ATD therapy should be used for overt...
...men who develop hyperthyroidism duri...
...he ATA suggests that women with hypert...
...h hyperthyroidism caused by GD who are well contro...
...The ATA suggests that women who are treated...
...ATA suggests that a woman who tests positive f...
96. The ATA suggests that the physician co...
.... The ATA suggests that women in ear...
...omen taking PTU during the 1st trimester of pregn...
...during pregnancy should be treated with the low...
...Pregnancy is a relative contraindication to thyr...
...dectomy is necessary for the treatment of...
...n thyroidectomy is necessary for th...
.... Patients who were treated with RA...
...ents receiving ATD for GD when becoming p...
...Patients with elevated TRAb level...
...ostpartum Thyroidi...
...veloping thyrotoxicosis after delive...
...with symptomatic thyrotoxicosis from post...
.... In pregnant women diagnosed with h...
...mmary of Recommendations Concerning Ma...
Other Conditions
...her Conditions
...iated Thyrotoxicosis...
...ble 13. Causes of Drug-Associated ThyrotoxicosisHa...
...nts taking medications known to caus...
...ine-induced Hyperthy...
.... Routine administration of ATDs be...
...energic blocking agents alone or in combinat...
...induced Thyrotoxicosis (AIT)...
...gests monitoring thyroid function tests be...
113. The decision to stop amiodarone in the setti...
...14. In clinically stable patients with AIT,...
...be used to treat overt thyrotoxicosis in pat...
...ed ATD and corticosteroid therapy should be...
...Patients with AIT who are unresponsive to...
...A Suggested Approach to the Management of AIT...
...uctive Thyroiditi...
...cute Thyroiditi...
...8. Patients with mild symptomatic subacute th...
...nless Thyroiditis
...atients with symptomatic thyrotoxic...
...e Thyroiditis
...cute thyroiditis should be treated with antibiot...
...auses of Thyrotoxicosis...
...nusual Causes of ThyrotoxicosisHav...
...ecreting Pituitary Tumors...
...diagnosis of a TSH-secreting pituitary adenom...
...tients with TSH-secreting pituitary a...
...truma Ovari...
...ts with struma ovarii should be treated...
...riocarcino...
...eatment of hyperthyroidism due to choriocarc...
Appendix
...pendix...
Table 15. Theoretical Projections of Cancer...