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
Determination of...
...of thyrotoxicosis should be determined....
Table 1. Causes of ThyrotoxicosisHaving troub...
Symptomatic Management
...atic Management...
...gic blockade is recommended in all patie...
...renergic Receptor Blockade in the T...
Graves' Disease
...aves' Disease...
...able 3. Clinical Situations That Favor a Particula...
.... Patients with overt Graves' hyperthyroidi...
...AI...
...ause RAI treatment of GD can cause a transient e...
...dition to β-adrenergic blockade (see Recs. 2...
...nts who are at increased risk for complic...
...ical therapy of any comorbid condit...
...t activity of RAI should be administered...
...y test should be obtained within 48 ho...
...he physician administering RAI should p...
...ollow-up within the first 1–2 months after RAI...
.... When hyperthyroidism due to GD persists afte...
...TDs
...le (MMI) should be used in virtually every pat...
.... Patients should be informed of s...
...initiating ATD therapy for GD, the ATA...
...al white blood cell count should be ob...
...ufficient evidence to recommend for or against r...
...r function and hepatocellular integrity shoul...
...nsufficient information to recomme...
...neous reactions may be managed with con...
...Measurement of TRAb levels prior to...
...If MMI is chosen as the primary therapy for...
...nt with GD becomes hyperthyroid after compl...
...odine
...odide may be of benefit in select patients with h...
...yroidectomy...
.... If surgery is chosen as treatment for...
...cium and 25-OH-vitamin D should be ass...
...eptional circumstances, when it is...
28. If surgery is chosen as the primary...
...is chosen as the primary therapy for GD, th...
...thyroidectomy for GD, alternative strategi...
...ATD should be stopped at the time of thyroidect...
...ing thyroidectomy for GD, L-thyrox...
...n among different members of the multi...
Thyroid Nodules...
...If a thyroid nodule is discovered in a...
...hyroid Stor...
...sis of thyroid storm should be made clinic...
...imodality treatment approach to patients with thy...
...Scale for the Diagnosis of Thyroid StormHaving...
...ble 5. Thyroid Storm: Drugs and DosesHaving troubl...
...#39; Orbitopathy (GO)...
...ssessment of GO: Clinical Activity Score Elem...
...everity AssessmentHaving trouble viewing table?...
...m should be expeditiously achieved and...
...ATA recommends clinicians advise patients w...
...g patients with GD without apparen...
40. In smoking patients with GD with...
...There is insufficient evidence to recommend...
...patients with Graves’ hyperthyroidism who ha...
...he absence of any strong contraindication to GC...
...In GD patients with mild GO who are treated with...
...ents with active and moderate to se...
...In patients with inactive GO the ATA sugg...
...f Oral Glucocorticoids for Prevention of Graves...
Table 9. Risk Factors for Graves’ Orbitopath...
...ldren and Adolescent...
...enera...
...with GD should be treated with MMI, RAI t...
.... Beta adrenergic blockade is recommen...
...TD
49. MMI should be used in children who...
...tients and their caretakers should be inf...
...itiating ATD therapy, the ATA suggests that ped...
...ATDs should be stopped immediately, and white b...
...general, PTU should not be used in children....
...nt minor cutaneous reactions to MM...
...5. If MMI is chosen as the first-line treatm...
...or Cancer Risk See Table...
...ediatric patients with GD who are not...
...suggests that children with GD having total T4...
...therapy is chosen as treatment for...
Surgery
...dren with GD undergoing thyroidectomy should...
...ery is chosen as therapy for GD in childr...
...ctomy in children should be performed by high-vol...
TMNG or TA
...G or TA...
...e ATA suggests that patients with over...
...able 10. Clinical Situations That Favor a...
RAI
...ecause RAI treatment of TMNG or TA can cause...
...ddition to β-adrenergic blockade (see...
...ts who are at increased risk for complications d...
...ioning nodules on radionuclide scintigraphy or n...
...nt activity of RAI should be administered...
...ient activity of RAI should be administered...
...llow-up within the first 1–2 months...
...perthyroidism persists beyond 6 months following R...
...rgery...
71. If surgery is chosen as treatment for TMNG or...
...surgery is chosen as treatment for TM...
...TMNG should be performed by a high-v...
...gery is chosen as the treatment for TA, a thyr...
...The ATA suggests that surgery for TA be p...
...ollowing thyroidectomy for TMNG, serum calciu...
...d be stopped at the time of surgery for...
78. Following thyroidectomy for TM...
...lobectomy for TA, TSH and estimated free T4 l...
...AI therapy should be used for retreatment of...
...TDs
...erm MMI treatment of TMNG or TA might be indicated...
...nol or Radiofrequency Ablation...
...Alternative therapies such as ethanol or radiofr...
Subclinical Hyperthyroidism and Pregnancy
...inical Hyperthyroidism and Preg...
...bclinical Hyperthyroidis...
...TSH is persistently...
84. When TSH is persi...
...persistently below the lower limit of normal b...
...TSH is persistently below the lower li...
...to be treated, the treatment should be based o...
...e 11. Subclinical Hyperthyroidism: When to TreatH...
...egnanc...
88. The diagnosis of hyperthyroidism in p...
...hCG-mediated TSH suppression in ea...
...therapy should be used for overt hyper...
...develop hyperthyroidism during their reproducti...
92. The ATA suggests that women with hypert...
...hyperthyroidism caused by GD who are we...
...he ATA suggests that women who are treated w...
...The ATA suggests that a woman who tests posit...
...e ATA suggests that the physician contacted...
...A suggests that women in early pregnancy who have...
...taking PTU during the 1st trimester o...
...uring pregnancy should be treated with the lowes...
...Pregnancy is a relative contraindication to...
...roidectomy is necessary for the treatment of hyper...
...dectomy is necessary for the treatment of hype...
...ts who were treated with RAI or thyroidectom...
...ceiving ATD for GD when becoming pregnant or...
...s with elevated TRAb levels at 18â€...
...tpartum Thyroidi...
...veloping thyrotoxicosis after delivery, se...
...omen with symptomatic thyrotoxicosis from postpar...
...nt women diagnosed with hyperthyroi...
...12. Summary of Recommendations Concerning Manage...
Other Conditions
Other Conditio...
...ug-Associated Thyrotoxic...
...e 13. Causes of Drug-Associated ThyrotoxicosisHa...
...ts taking medications known to cause thyr...
...ine-induced Hyperthyroidism...
...administration of ATDs before iodinated c...
...Beta-adrenergic blocking agents alone o...
...rone-induced Thyrotoxicosis (AIT)...
...e ATA suggests monitoring thyroid func...
...3. The decision to stop amiodarone in the settin...
...nically stable patients with AIT, t...
...ld be used to treat overt thyrotoxicosis in...
116. Combined ATD and corticosteroid therapy...
...nts with AIT who are unresponsive to aggres...
Figure 1. A Suggested Approach to the Management o...
Destructive Thyroiditis
...ubacute Thyroidit...
...tients with mild symptomatic subacute thyroidit...
...nless Thyroiditi...
...ents with symptomatic thyrotoxicos...
Acute Thyroi...
...20. Acute thyroiditis should be treat...
Unusual Causes of Thyrotoxicos...
...le 14. Unusual Causes of ThyrotoxicosisHa...
TSH-Secreting Pituitary Tumor...
...sis of a TSH-secreting pituitary adenoma should...
...22. Patients with TSH-secreting pit...
...uma Ovari...
123. Patients with struma ovarii should...
...riocarcinoma...
...nt of hyperthyroidism due to chorio...
Appendix
Appendix
...e 15. Theoretical Projections of Cancer I...