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

...ation of Etiology...

.... The etiology of thyrotoxicosis should be determ...


...auses of ThyrotoxicosisHaving trouble view...


Symptomatic Management

Symptomatic Manage...

...gic blockade is recommended in all patien...


...-Adrenergic Receptor Blockade in the Treatment o...


Graves' Disease

...raves' Dise...

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


...with overt Graves' hyperthyroidism s...


...AI

...treatment of GD can cause a transient exac...

...dition to β-adrenergic blockade (see Recs. 2...

...ts who are at increased risk for com...

...therapy of any comorbid conditions should be optim...

...ficient activity of RAI should be administered...

...test should be obtained within 48 h...

10. The physician administering RAI should pro...

...ithin the first 1–2 months after RA...

.... When hyperthyroidism due to GD persis...


ATD...

...ole (MMI) should be used in virtually every...

...ients should be informed of side effe...

...nitiating ATD therapy for GD, the ATA suggests t...

...ntial white blood cell count should be...

...here is insufficient evidence to recommend fo...

18. Liver function and hepatocellular integrity...

...insufficient information to recommend for o...

...aneous reactions may be managed with concurrent a...

...ent of TRAb levels prior to stopping ATD th...

...I is chosen as the primary therapy for GD, the...

...patient with GD becomes hyperthyroi...


...odine...

...ium iodide may be of benefit in selec...


...roidectomy...

...5. If surgery is chosen as treatment for GD,...

...m and 25-OH-vitamin D should be as...

...n exceptional circumstances, when it is...

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

...9. If surgery is chosen as the primary...

...wing thyroidectomy for GD, alternative...

...1. ATD should be stopped at the time of th...

...owing thyroidectomy for GD, L-thyroxine should be...

...munication among different members of the mult...


...oid Nodules in GD...

...nodule is discovered in a patient...


...oid Storm...

...s of thyroid storm should be made cli...

...ltimodality treatment approach to patients with...

...Scale for the Diagnosis of Thyroid S...

...Thyroid Storm: Drugs and DosesHav...


...#39; Orbitopathy (GO)...

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

...7. GO Severity AssessmentHaving trouble vie...

...m should be expeditiously achieved...

...ommends clinicians advise patients with GD...

...onsmoking patients with GD without apparent GO, RA...

...ing patients with GD without appare...

...is insufficient evidence to recommend...

...with Graves’ hyperthyroidism who have mild ac...

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

...4. In GD patients with mild GO who are treated w...

...ents with active and moderate to s...

...with inactive GO the ATA suggests R...

...Oral Glucocorticoids for Prevention of Graves...

.... Risk Factors for Graves’ OrbitopathyHaving t...


...ildren and Adolescents...

...neral

...ith GD should be treated with MMI, RAI therapy,...

...ta adrenergic blockade is recommended for childr...

ATD

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

...atric patients and their caretakers should be inf...

...ior to initiating ATD therapy, the ATA...

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

...general, PTU should not be used in child...

...4. Persistent minor cutaneous reactions to MMI the...

...MI is chosen as the first-line treatment for GD in...

...Cancer Risk See Table 15)...

...c patients with GD who are not in remission fo...

...he ATA suggests that children with GD ha...

58. If RAI therapy is chosen as treatment for GD i...

...rgery

...dren with GD undergoing thyroidectomy should...

...0. If surgery is chosen as therapy for GD in ch...

...Thyroidectomy in children should be...


TMNG or TA

TMNG or...

...A suggests that patients with overtly TMNG...


...al Situations That Favor a Particular...


RAI

...I treatment of TMNG or TA can cause a tr...

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

.... In patients who are at increased ri...

...oning nodules on radionuclide scintigr...

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

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

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

...roidism persists beyond 6 months followi...


...rgery...

...urgery is chosen as treatment for TMNG...

...urgery is chosen as treatment for TMNG, ne...

...TMNG should be performed by a high-volume thyroid...

...f surgery is chosen as the treatment fo...

...ATA suggests that surgery for TA be performed...

...thyroidectomy for TMNG, serum calcium ± iPTH...

...should be stopped at the time of s...

...ollowing thyroidectomy for TMNG, thyroid...

...9. Following lobectomy for TA, TSH an...

...herapy should be used for retreatment...


...TDs...

...term MMI treatment of TMNG or TA mi...


...or Radiofrequency Ablation...

...e therapies such as ethanol or radio...


Subclinical Hyperthyroidism and Pregnancy

...cal Hyperthyroidism and Pregnancy...

...ubclinical Hyperthyroidism (SH)

...en TSH is persistently...

...en TSH is persistent...

...When TSH is persistently below the lowe...

...When TSH is persistently below the lower...

...If SH is to be treated, the treatmen...


...e 11. Subclinical Hyperthyroidism: W...


...regnan...

88. The diagnosis of hyperthyroidis...

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

...ATD therapy should be used for ove...

...1. In women who develop hyperthyroidis...

...ATA suggests that women with hyperthyroidism cau...

...en with hyperthyroidism caused by GD who are we...

...ggests that women who are treated with ATD a...

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

...he ATA suggests that the physician cont...

...suggests that women in early pregnancy who have a...

...omen taking PTU during the 1st trimester of preg...

...regnancy should be treated with the lowest...

100. Pregnancy is a relative contraindicati...

...When thyroidectomy is necessary for...

...yroidectomy is necessary for the treatment...

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

...atients receiving ATD for GD when becoming pregn...

...tients with elevated TRAb levels at...


...artum Thyroiditis...

...06. In women developing thyrotoxicosis after del...

...07. In women with symptomatic thyrotoxicosi...

...t women diagnosed with hyperthyroidism...


...e 12. Summary of Recommendations Concerning Manage...


Other Conditions

...er Conditions...

...ciated Thyrotoxicosis...

...es of Drug-Associated Thyrotoxicosis...

...9. Patients taking medications known to cause...


...duced Hyperthyroidis...

...inistration of ATDs before iodinated contrast med...

...a-adrenergic blocking agents alone or in...


...iodarone-induced Thyrotoxicosis (AIT...

...2. The ATA suggests monitoring thyro...

113. The decision to stop amiodarone i...

...ally stable patients with AIT, the ATA sugge...

...be used to treat overt thyrotoxicosis in pat...

...d ATD and corticosteroid therapy should be use...

...Patients with AIT who are unrespons...


...Suggested Approach to the Management of A...


...uctive Thyroiditis...

...acute Thyroiditi...

...atients with mild symptomatic subacute thyroidi...

...less Thyroiditis...

...with symptomatic thyrotoxicosis due to painle...

...Thyroiditis...

...thyroiditis should be treated with antibio...


...nusual Causes of Thyrotoxicos...

.... Unusual Causes of ThyrotoxicosisHaving trou...


TSH-Secreting Pituitary Tumors

...iagnosis of a TSH-secreting pituitary ad...

...with TSH-secreting pituitary adenoma...


...ma Ovarii...

...23. Patients with struma ovarii sho...


Choriocarci...

...tment of hyperthyroidism due to choriocarcinoma s...


Appendix

...pendix...

...oretical Projections of Cancer Incidence or...