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
...ermination of Etiol...
...gy of thyrotoxicosis should be determined. If...
...le 1. Causes of ThyrotoxicosisHaving trouble view...
Symptomatic Management
Symptomatic Manage...
...energic blockade is recommended in all patien...
...2. Beta-Adrenergic Receptor Blockade in th...
Graves' Disease
Graves' Dis...
...ical Situations That Favor a Particu...
...with overt Graves' hyperthyroidism should be...
RAI
.... Because RAI treatment of GD can ca...
...ddition to β-adrenergic blockade...
...patients who are at increased risk for compli...
...Medical therapy of any comorbid cond...
...ient activity of RAI should be administered...
...test should be obtained within 48...
...0. The physician administering RAI should...
...ollow-up within the first 1–2 months after...
...n hyperthyroidism due to GD persists after 6 mont...
...TDs
...imazole (MMI) should be used in virtually every pa...
...4. Patients should be informed of side effects of...
...to initiating ATD therapy for GD, the ATA su...
...tial white blood cell count should...
...here is insufficient evidence to recomme...
...er function and hepatocellular integrity should...
...is insufficient information to recommen...
...Minor cutaneous reactions may be managed wi...
...t of TRAb levels prior to stopping A...
...I is chosen as the primary therapy for GD, the me...
...tient with GD becomes hyperthyroid aft...
...dine...
...ium iodide may be of benefit in sele...
...yroidectomy...
...5. If surgery is chosen as treatment for G...
...and 25-OH-vitamin D should be asses...
27. In exceptional circumstances, when it i...
...ery is chosen as the primary therapy for GD, near...
...is chosen as the primary therapy fo...
...lowing thyroidectomy for GD, alternative strate...
...should be stopped at the time of thyroidectomy...
...Following thyroidectomy for GD, L-thyroxine shoul...
...ion among different members of the multidisc...
...Nodules in GD
...roid nodule is discovered in a patient with...
Thyroid Sto...
...diagnosis of thyroid storm should be made clini...
...ltimodality treatment approach to patients with t...
...le 4. Point Scale for the Diagnosis of Thyr...
...able 5. Thyroid Storm: Drugs and Dose...
...' Orbitopathy (...
...ble 6. Assessment of GO: Clinical Activity Scor...
...verity AssessmentHaving trouble vie...
...idism should be expeditiously achie...
...TA recommends clinicians advise patients with...
...onsmoking patients with GD without app...
...smoking patients with GD without apparent G...
...insufficient evidence to recommend for or agai...
42. In patients with Graves’ hyperth...
...bsence of any strong contraindication to GC...
...n GD patients with mild GO who are treated w...
.... In patients with active and moderate to sev...
...nts with inactive GO the ATA suggests RAI ther...
...Oral Glucocorticoids for Prevention o...
...sk Factors for Graves’ OrbitopathyHavin...
...en and Adolescents...
...neral...
...ren with GD should be treated with MMI, RAI thera...
...ergic blockade is recommended for children e...
...TD...
...I should be used in children who are t...
...ric patients and their caretakers should be inform...
51. Prior to initiating ATD therapy,...
...uld be stopped immediately, and white blood cou...
...n general, PTU should not be used in child...
54. Persistent minor cutaneous reactions to MMI...
...If MMI is chosen as the first-line tr...
...or Cancer Risk See Table 15)...
...atients with GD who are not in remission f...
...gests that children with GD having total T4...
...py is chosen as treatment for GD in...
...urgery...
...dren with GD undergoing thyroidectomy shoul...
...f surgery is chosen as therapy for GD in chi...
...hyroidectomy in children should be performed by...
TMNG or TA
...NG or TA...
...The ATA suggests that patients with overtly...
...cal Situations That Favor a Particular Modalit...
...AI
.... Because RAI treatment of TMNG or TA ca...
...on to β-adrenergic blockade (see Recs. 2 & 63) p...
...In patients who are at increased risk...
...6. Nonfunctioning nodules on radionu...
...icient activity of RAI should be administered in a...
...icient activity of RAI should be admi...
...ithin the first 1–2 months after RAI...
.... If hyperthyroidism persists beyond 6 months f...
...rgery...
...ery is chosen as treatment for TMNG o...
.... If surgery is chosen as treatment for TMNG...
...gery for TMNG should be performed by a hi...
...gery is chosen as the treatment for TA, a...
...suggests that surgery for TA be performed by...
...ng thyroidectomy for TMNG, serum calcium Â...
...should be stopped at the time of surgery for...
...Following thyroidectomy for TMNG, thyroi...
...9. Following lobectomy for TA, TSH an...
...therapy should be used for retreatm...
...TDs
81. Long-term MMI treatment of TMNG or TA might...
...hanol or Radiofrequency...
...2. Alternative therapies such as eth...
Subclinical Hyperthyroidism and Pregnancy
...inical Hyperthyroidism and Pregnancy...
...al Hyperthyroidism (SH)...
.... When TSH is persist...
...n TSH is persistently...
...hen TSH is persistently below the lower lim...
.... When TSH is persistently below the lower limit...
.... If SH is to be treated, the treatment shoul...
...ble 11. Subclinical Hyperthyroidism: When to Trea...
...gnancy
...osis of hyperthyroidism in pregnan...
...ent hCG-mediated TSH suppression in early pre...
...y should be used for overt hyperthyroidism due...
.... In women who develop hyperthyroidism during th...
...TA suggests that women with hyperthyroidism c...
...Women with hyperthyroidism caused by...
...ests that women who are treated with ATD a...
...ggests that a woman who tests positive for pr...
96. The ATA suggests that the physician...
...gests that women in early pregnancy...
...en taking PTU during the 1st trimester...
...egnancy should be treated with the...
...s a relative contraindication to thyroidectomy, wh...
...idectomy is necessary for the treatment of hype...
102. When thyroidectomy is necessary for t...
.... Patients who were treated with RAI...
...04. Patients receiving ATD for GD when...
...Patients with elevated TRAb levels...
...partum Thyroiditi...
...6. In women developing thyrotoxicosis afte...
...with symptomatic thyrotoxicosis from pos...
...women diagnosed with hyperthyroidism due to mul...
...le 12. Summary of Recommendations Concerning M...
Other Conditions
...her Conditio...
Drug-Associated Thyrotoxic...
...Causes of Drug-Associated ThyrotoxicosisHa...
.... Patients taking medications know...
...odine-induced Hyperthy...
...ine administration of ATDs before iodinated cont...
...a-adrenergic blocking agents alone...
...nduced Thyrotoxicosis (AIT)...
...e ATA suggests monitoring thyroid functio...
...ion to stop amiodarone in the setting o...
...lly stable patients with AIT, the AT...
.... MMI should be used to treat overt thyr...
...ombined ATD and corticosteroid the...
...17. Patients with AIT who are unresponsive to agg...
...ure 1. A Suggested Approach to the Man...
...uctive Thyroiditis...
Subacute Thyroidi...
...18. Patients with mild symptomatic suba...
...ss Thyroiditis
...with symptomatic thyrotoxicosis due to painles...
...te Thyroiditis
...20. Acute thyroiditis should be treated wi...
...uses of Thyrotoxicosis...
...le 14. Unusual Causes of ThyrotoxicosisHavin...
...Secreting Pituitary Tumors
...he diagnosis of a TSH-secreting pituitary a...
...2. Patients with TSH-secreting pituitary adenoma...
...ma Ovarii...
...s with struma ovarii should be treated initially...
...ocarcinoma...
...t of hyperthyroidism due to choriocarcinoma sh...
Appendix
...ppendix
...ble 15. Theoretical Projections of Cancer Inciden...