Table Of Contents
Hyperthyroidism
Hyperthyroidism is an elevation of thyroid hormone (T3 and T4).
Classification
| Classification | Description | Examples |
|---|---|---|
| Primary hyperthyroidism | Elevated thyroid hormone due to increased autonomous production by the thyroid gland. Has a low TSH, high T3 and T4 | Grave’s disease, Toxic nodular goiter (single toxic adenoma, toxic multinodular goiter), Thyroiditis (subacute, lymphocytic, post-partum), Struma ovarii, Hashitoxicosis, Exogenous intake (factitious disorder), Iodine-induced (Jod-Basedow’s syndrome), Hydatidiform moles and thyroid carcinoma |
| Secondary hyperthyroidism | Elevated thyroid hormone due to increased stimulation of the thyroid gland. Has a high TSH, high T3 and T4 | Pituitary adenoma, Amiodarone-induced hyperthyroidism |
Most likely diagnosis
| Unique feature | Diagnosis |
|---|---|
| Proptosis (30%) and skin (5%) findings, diffuse enlargement (goiter) | Graves disease |
| Tender thyroids | Subacute thyroiditis |
| Non-tender, normal exam results | Painless ‘silent’ thyroiditis |
| Involuted, gland not palpable | Exogenous thyroid hormone use |
| High TSH level | Pituitary ademona |
- Signs and symptoms
- Nervousness (mania)
- Emotional lability (mania)
- Tremor
- Insomnia
- Sweating
- Heat intolerance
- Weight loss despite increased appetite
- Diarrhoea
- Palpitations (atrial fibrillation)
- Warm/moist skin
- Menstrual changes i.e. polymenorrhoea
- Hypercalcemia
- Differentials
- Primary hyperthyroidism: low TSH, high T3 and T4
- Secondary hyperthyroidism: high TSH, high T3 and T4
- Pheochromocytoma
- Acute manic episode
- Intoxication: cocaine, amphetamine
- Investigation
- Thyroid Function Test
- Urine toxicology screen
First line treatment
| Condition | First-line treatment |
|---|---|
| Grave’s disease | Anti-thyroid medications |
| Toxic adenoma | Thyroid lobectomy |
| Toxic Multinodular Goiter | Total thyroidectomy |
