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
...etermination of Etiol...
...ology of thyrotoxicosis should be determined. If t...
...es of ThyrotoxicosisHaving trouble vi...
Symptomatic Management
...ptomatic Management...
...drenergic blockade is recommended in all patient...
...renergic Receptor Blockade in the T...
Graves' Disease
...' Disease...
...cal Situations That Favor a Partic...
...th overt Graves' hyperthyroidism sho...
RAI
...ause RAI treatment of GD can cause...
...o β-adrenergic blockade (see Recs. 2 & 4), p...
...patients who are at increased risk for complicat...
...Medical therapy of any comorbid conditio...
...ufficient activity of RAI should be administer...
.... A pregnancy test should be obtained wit...
...0. The physician administering RAI should provide...
...ollow-up within the first 1–2 months af...
...rthyroidism due to GD persists after 6 months f...
...TDs
...le (MMI) should be used in virtually every patient...
...ould be informed of side effects of ATDs and the...
.... Prior to initiating ATD therapy for GD, the...
...differential white blood cell count sh...
...nsufficient evidence to recommend for or...
...tion and hepatocellular integrity should be...
...sufficient information to recommend for or agains...
...Minor cutaneous reactions may be managed with...
...ement of TRAb levels prior to stopping ATD...
...is chosen as the primary therapy for GD, the medi...
...nt with GD becomes hyperthyroid after co...
...odine
24. Potassium iodide may be of ben...
...hyroidect...
...ry is chosen as treatment for GD, patients shoul...
...nd 25-OH-vitamin D should be assessed preope...
...tional circumstances, when it is not pos...
...gery is chosen as the primary ther...
...surgery is chosen as the primary therapy for GD,...
...ollowing thyroidectomy for GD, alternat...
...ATD should be stopped at the time of thyroidect...
...wing thyroidectomy for GD, L-thyroxine s...
...on among different members of the multidi...
...d Nodules in GD...
...roid nodule is discovered in a patient...
...oid Storm...
...s of thyroid storm should be made clinically in...
...modality treatment approach to patie...
...Point Scale for the Diagnosis of Thyro...
...e 5. Thyroid Storm: Drugs and DosesHaving...
...' Orbitopathy (GO)...
...sment of GO: Clinical Activity Score ElementsH...
...everity AssessmentHaving trouble viewing table...
.... Euthyroidism should be expeditiousl...
...ATA recommends clinicians advise patients wi...
...ng patients with GD without apparent GO, RAI the...
...ing patients with GD without apparent GO,...
...1. There is insufficient evidence to recomme...
...In patients with Graves’ hyperthyroidism who...
...bsence of any strong contraindicatio...
...In GD patients with mild GO who are treated w...
...patients with active and moderate to severe or s...
...tients with inactive GO the ATA sugges...
...Use of Oral Glucocorticoids for Prevention of Gra...
...ctors for Graves’ OrbitopathyHaving trouble view...
...and Adolescents...
...neral...
...ren with GD should be treated with MMI...
...Beta adrenergic blockade is recommended for child...
...TD
...ld be used in children who are treated wit...
...Pediatric patients and their caretakers sh...
...tiating ATD therapy, the ATA suggests...
...should be stopped immediately, and white blood cou...
...l, PTU should not be used in children. Bu...
...minor cutaneous reactions to MMI therapy in...
...MMI is chosen as the first-line treatm...
...For Cancer Risk See Table...
...atients with GD who are not in remission...
...TA suggests that children with GD having total T4...
...therapy is chosen as treatment for...
...urger...
...ldren with GD undergoing thyroidectomy should be...
.... If surgery is chosen as therapy f...
61. Thyroidectomy in children should...
TMNG or TA
...G or TA
...gests that patients with overtly TMNG or T...
...10. Clinical Situations That Favor a Particul...
...AI
...e RAI treatment of TMNG or TA can cause a t...
...addition to β-adrenergic blockad...
...patients who are at increased risk for complica...
...6. Nonfunctioning nodules on radionuclide...
...7. Sufficient activity of RAI should be...
...ufficient activity of RAI should be administered i...
...up within the first 1–2 months after...
...yperthyroidism persists beyond 6 months foll...
...urger...
...ery is chosen as treatment for TMNG or TA...
...ry is chosen as treatment for TMNG, near-to...
...r TMNG should be performed by a high-volume thy...
...s chosen as the treatment for TA,...
...TA suggests that surgery for TA be performed by a...
...owing thyroidectomy for TMNG, serum calcium ± iPT...
...MMI should be stopped at the time of surgery for T...
...wing thyroidectomy for TMNG, thyro...
...llowing lobectomy for TA, TSH and estimated fr...
...AI therapy should be used for retreatment...
...TDs...
.... Long-term MMI treatment of TMNG or T...
...r Radiofrequency Ablation...
.... Alternative therapies such as ethan...
Subclinical Hyperthyroidism and Pregnancy
...ubclinical Hyperthyroidism and Pregnan...
...inical Hyperthyroidism (SH)...
...When TSH is persistently...
...TSH is persistently...
...persistently below the lower limit...
...is persistently below the lower limit of normal...
...SH is to be treated, the treatment should be bas...
...le 11. Subclinical Hyperthyroidism: When t...
...egnanc...
...s of hyperthyroidism in pregnancy shoul...
...ient hCG-mediated TSH suppression in early...
...therapy should be used for overt hyperthyroidis...
...omen who develop hyperthyroidism during their r...
...suggests that women with hyperthyroidism ca...
...Women with hyperthyroidism caused by GD who are w...
...suggests that women who are treated with ATD...
...ggests that a woman who tests positive for pre...
...ests that the physician contacted according to Re...
97. The ATA suggests that women in early pregnan...
...g PTU during the 1st trimester of p...
...uring pregnancy should be treated w...
...Pregnancy is a relative contraindi...
...n thyroidectomy is necessary for the treatmen...
...thyroidectomy is necessary for the treatment of h...
...ho were treated with RAI or thyroidectomy for...
104. Patients receiving ATD for GD when becoming...
...ts with elevated TRAb levels at 18â€...
...ostpartum Thyroiditis...
...In women developing thyrotoxicosis after delive...
...th symptomatic thyrotoxicosis from postpartum des...
...regnant women diagnosed with hyperthyroidism...
Table 12. Summary of Recommendations Con...
Other Conditions
...her Conditions...
...rug-Associated Thyrotoxicosi...
...es of Drug-Associated ThyrotoxicosisHa...
...ients taking medications known to ca...
...odine-induced Hyperthyroidi...
...outine administration of ATDs before iod...
...ergic blocking agents alone or in combinatio...
...iodarone-induced Thyrotoxicosis (AIT)...
...ggests monitoring thyroid function...
...cision to stop amiodarone in the setting of thyro...
...lly stable patients with AIT, the ATA suggests mea...
...hould be used to treat overt thyro...
...16. Combined ATD and corticosteroid therapy sh...
...tients with AIT who are unresponsive to ag...
...e 1. A Suggested Approach to the Manage...
...ctive Thyroiditi...
...acute Thyroiditis...
...s with mild symptomatic subacute thyroiditis sh...
...ss Thyroiditis...
...tients with symptomatic thyrotoxicosis due to...
Acute Thyroiditi...
...hyroiditis should be treated with antib...
...auses of Thyrotoxicosis...
...al Causes of ThyrotoxicosisHaving t...
...H-Secreting Pituitary Tumors...
...osis of a TSH-secreting pituitary adenoma shoul...
...22. Patients with TSH-secreting pituit...
...truma Ovarii...
...tients with struma ovarii should be treated...
...iocarcinoma...
.... Treatment of hyperthyroidism due to choriocarc...
Appendix
...pendix...
Table 15. Theoretical Projections of Cancer Inci...