Hyperthyroidism

Publication Date: October 1, 2016

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...

...ology of thyrotoxicosis should be d...


...s of ThyrotoxicosisHaving trouble view...


Symptomatic Management

...omatic Management...

...nergic blockade is recommended in all patients...


Table 2. Beta-Adrenergic Receptor...


Graves' Disease

Graves' Disease

...3. Clinical Situations That Favor a...


...ients with overt Graves' hyperthyroidism should...


...AI...

...reatment of GD can cause a transient exacerb...

5. In addition to β-adrenergic blockade (see...

...patients who are at increased risk for complicatio...

...erapy of any comorbid conditions should be opti...

...icient activity of RAI should be a...

...ancy test should be obtained within 48 hours pr...

...The physician administering RAI should provide...

...ow-up within the first 1–2 months after RA...

...yperthyroidism due to GD persists after 6 m...


...TDs...

...azole (MMI) should be used in virtual...

...should be informed of side effects of ATDs and the...

...initiating ATD therapy for GD, the AT...

...ial white blood cell count should b...

...There is insufficient evidence to recom...

...function and hepatocellular integrity s...

...ufficient information to recommend for o...

...eous reactions may be managed with concurren...

...nt of TRAb levels prior to stopping ATD t...

...osen as the primary therapy for GD, the...

...atient with GD becomes hyperthyroid after...


...dine

...m iodide may be of benefit in select...


Thyroidectom...

...ery is chosen as treatment for GD,...

...and 25-OH-vitamin D should be assessed preope...

...ional circumstances, when it is not p...

...surgery is chosen as the primary the...

...is chosen as the primary therapy...

...g thyroidectomy for GD, alternative...

...ould be stopped at the time of thyroidectom...

...ng thyroidectomy for GD, L-thyroxine should...

...Communication among different member...


...Nodules in GD...

34. If a thyroid nodule is discovered in a pati...


...hyroid Storm

...The diagnosis of thyroid storm should be made c...

...6. A multimodality treatment approach t...

...4. Point Scale for the Diagnosis of Thyroid Stor...

...5. Thyroid Storm: Drugs and DosesHaving tr...


...ves' Orbitopathy...

...Assessment of GO: Clinical Activity Score Elem...

...everity AssessmentHaving trouble viewing table?...

...Euthyroidism should be expeditiously...

...A recommends clinicians advise patient...

...In nonsmoking patients with GD without appare...

...moking patients with GD without apparent GO, RAI...

...There is insufficient evidence to recommend fo...

...nts with Graves’ hyperthyroidism who have mi...

...n the absence of any strong contraindication to GC...

...atients with mild GO who are treat...

...ts with active and moderate to severe or...

...ents with inactive GO the ATA suggests RAI t...

...le 8. Use of Oral Glucocorticoids for Preventi...

...k Factors for Graves’ OrbitopathyH...


...en and Adolescent...

General

47. Children with GD should be trea...

...ta adrenergic blockade is recommended for c...

ATD

...be used in children who are treated with...

...diatric patients and their caretakers should...

...initiating ATD therapy, the ATA suggests that pe...

...hould be stopped immediately, and white blood c...

...neral, PTU should not be used in children....

...rsistent minor cutaneous reactions to MMI thera...

...If MMI is chosen as the first-line treatme...

RAI (For Cancer Risk See Table...

...6. Pediatric patients with GD who are not in re...

...ests that children with GD having total T4...

...apy is chosen as treatment for GD in childre...

...rgery...

...en with GD undergoing thyroidectomy shoul...

60. If surgery is chosen as therapy for GD in...

...my in children should be performed by high-v...


TMNG or TA

...MNG or T...

...TA suggests that patients with overtly TMN...


...e 10. Clinical Situations That Favor a Part...


RAI

...ecause RAI treatment of TMNG or TA can cause a tra...

...on to β-adrenergic blockade (see Recs. 2 & 63...

65. In patients who are at increas...

.... Nonfunctioning nodules on radionuclide scintig...

...activity of RAI should be administered in a singl...

...8. Sufficient activity of RAI should be administer...

...within the first 1–2 months after RAI the...

...hyroidism persists beyond 6 months followin...


...urgery

...s chosen as treatment for TMNG or TA, pati...

...surgery is chosen as treatment for TMN...

...rgery for TMNG should be performed by a...

...is chosen as the treatment for TA, a thyroid ult...

75. The ATA suggests that surgery fo...

...ollowing thyroidectomy for TMNG, serum cal...

...be stopped at the time of surgery for TM...

...llowing thyroidectomy for TMNG, thyroi...

...obectomy for TA, TSH and estimated free T4 level...

...y should be used for retreatment of persiste...


...TDs...

...Long-term MMI treatment of TMNG or TA might be in...


...anol or Radiofrequency A...

...2. Alternative therapies such as ethanol o...


Subclinical Hyperthyroidism and Pregnancy

...Hyperthyroidism and Pregnancy...

...cal Hyperthyroidism (SH)...

...When TSH is persiste...

...n TSH is persistently...

...n TSH is persistently below the lower limit of...

...is persistently below the lower limit of normal b...

...SH is to be treated, the treatment should be base...


...inical Hyperthyroidism: When to TreatH...


...egnanc...

88. The diagnosis of hyperthyroidism in pregnancy...

...nt hCG-mediated TSH suppression in early...

...should be used for overt hyperthyroidism...

...omen who develop hyperthyroidism during their re...

...A suggests that women with hyperth...

...omen with hyperthyroidism caused by G...

...suggests that women who are treated with...

...A suggests that a woman who tests positive...

.... The ATA suggests that the physician contacted ac...

...he ATA suggests that women in early pregnancy who...

...ing PTU during the 1st trimester of pregn...

...ng pregnancy should be treated with the low...

...y is a relative contraindication to...

...thyroidectomy is necessary for the treatment o...

...When thyroidectomy is necessary for the...

.... Patients who were treated with RAI or thyroidect...

...ceiving ATD for GD when becoming pregnant...

105. Patients with elevated TRAb levels at...


...tpartum Thyroiditis...

...n developing thyrotoxicosis after delivery, sel...

.... In women with symptomatic thyrotoxicosis from...

...n pregnant women diagnosed with hyperthyroidism...


Table 12. Summary of Recommendations Concerning...


Other Conditions

...Conditions...

...iated Thyrotoxicosis...

...s of Drug-Associated ThyrotoxicosisHaving trou...

...Patients taking medications known to cause thyrot...


...duced Hyperthyroidis...

...utine administration of ATDs before iodinated con...

...Beta-adrenergic blocking agents alone o...


...nduced Thyrotoxicosis (AIT)...

...ggests monitoring thyroid function te...

...n to stop amiodarone in the setting...

...lly stable patients with AIT, the ATA...

...ld be used to treat overt thyrotoxicosis...

...ned ATD and corticosteroid therapy should be used...

...ients with AIT who are unresponsive to agg...


...gested Approach to the Management of...


...structive Thyroi...

...bacute Thyroid...

...ts with mild symptomatic subacute thyroiditis s...

...inless Thyroiditis

...ients with symptomatic thyrotoxicosis due to pain...

...te Thyroiditis...

...Acute thyroiditis should be treated with a...


...al Causes of Thyrotoxicosis

.... Unusual Causes of ThyrotoxicosisHavin...


...Secreting Pituitary...

...agnosis of a TSH-secreting pituita...

...tients with TSH-secreting pituitary adenomas s...


...ruma Ovar...

...tients with struma ovarii should be treated i...


Choriocarcinoma

...ent of hyperthyroidism due to choriocarcinoma s...


Appendix

...ppendi...

...tical Projections of Cancer Incidence or C...