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
...nation of Etiology...
...ogy of thyrotoxicosis should be determi...
...of ThyrotoxicosisHaving trouble viewing tab...
Symptomatic Management
Symptomatic Manag...
...ic blockade is recommended in all pati...
...2. Beta-Adrenergic Receptor Blockade in the Tr...
Graves' Disease
...es' Disease
...inical Situations That Favor a Particular Moda...
...h overt Graves' hyperthyroidism sh...
...AI...
.... Because RAI treatment of GD can cause...
...ion to β-adrenergic blockade (see Recs. 2 & 4...
...patients who are at increased risk for complica...
...l therapy of any comorbid conditions...
...ctivity of RAI should be administered in a...
...y test should be obtained within 48 hours prior...
...The physician administering RAI should...
...within the first 1–2 months after RAI th...
...thyroidism due to GD persists after...
ATDs
...(MMI) should be used in virtually every patie...
...uld be informed of side effects of ATDs and...
...rior to initiating ATD therapy for GD, the...
...A differential white blood cell count should...
...nsufficient evidence to recommend fo...
...tion and hepatocellular integrity shou...
...insufficient information to recommend for o...
...or cutaneous reactions may be managed with c...
...ement of TRAb levels prior to stopp...
...f MMI is chosen as the primary thera...
.... If a patient with GD becomes hyperthyroid afte...
...odine
...assium iodide may be of benefit in s...
...hyroidectom...
...If surgery is chosen as treatment for GD...
...lcium and 25-OH-vitamin D should be assessed p...
...exceptional circumstances, when it is...
...y is chosen as the primary therapy for GD...
...9. If surgery is chosen as the primary therapy fo...
...thyroidectomy for GD, alternative stra...
...ATD should be stopped at the time...
.... Following thyroidectomy for GD, L-thyroxine...
...tion among different members of the multidi...
...id Nodules in GD...
.... If a thyroid nodule is discovered in a patien...
Thyroid Storm
...sis of thyroid storm should be made cl...
36. A multimodality treatment approach to pa...
...cale for the Diagnosis of Thyroid...
...able 5. Thyroid Storm: Drugs and DosesHaving tro...
...ves' Orbitopathy (GO)...
...sment of GO: Clinical Activity Score Eleme...
...verity AssessmentHaving trouble viewing t...
...Euthyroidism should be expeditiously achie...
...ommends clinicians advise patients w...
...nonsmoking patients with GD without apparen...
...n smoking patients with GD without apparent GO, RA...
...nsufficient evidence to recommend for or again...
...atients with Graves’ hyperthyroidism who...
...bsence of any strong contraindication to GC...
...patients with mild GO who are treated with RA...
...5. In patients with active and moderat...
...ts with inactive GO the ATA suggests RA...
...e 8. Use of Oral Glucocorticoids for...
...isk Factors for Graves’ Orbitopathy...
...en and Adolescent...
...neral
47. Children with GD should be treated with...
...gic blockade is recommended for children...
...TD...
...9. MMI should be used in children who are treate...
50. Pediatric patients and their caretakers s...
...o initiating ATD therapy, the ATA...
...s should be stopped immediately, and white blood...
...general, PTU should not be used in chi...
...4. Persistent minor cutaneous reactions...
...MMI is chosen as the first-line treatment for GD...
...or Cancer Risk See Table 15)...
...patients with GD who are not in remiss...
...uggests that children with GD having total T4...
...RAI therapy is chosen as treatment for GD in chi...
Surger...
...with GD undergoing thyroidectomy should be...
...rgery is chosen as therapy for GD in childr...
...y in children should be performed by high-v...
TMNG or TA
TMNG or T...
...gests that patients with overtly TMNG...
Table 10. Clinical Situations That Fav...
...AI
63. Because RAI treatment of TMNG or TA...
...tion to β-adrenergic blockade (see Recs....
...who are at increased risk for complicati...
...ctioning nodules on radionuclide sci...
...ficient activity of RAI should be administered...
...Sufficient activity of RAI should be adminis...
...p within the first 1–2 months after RAI...
...thyroidism persists beyond 6 months fol...
...rgery...
...If surgery is chosen as treatment for TMNG or...
72. If surgery is chosen as treatment fo...
73. Surgery for TMNG should be performed...
...urgery is chosen as the treatment for TA, a...
...suggests that surgery for TA be performed by a...
...lowing thyroidectomy for TMNG, serum ca...
...uld be stopped at the time of surgery for TMN...
78. Following thyroidectomy for TMN...
...ng lobectomy for TA, TSH and estimate...
...I therapy should be used for retreatm...
ATDs
...MI treatment of TMNG or TA might be indi...
...nol or Radiofrequency A...
...Alternative therapies such as ethanol...
Subclinical Hyperthyroidism and Pregnancy
...bclinical Hyperthyroidism and Pregnan...
...ubclinical Hyperthyroidi...
...hen TSH is persistentl...
.... When TSH is persisten...
...s persistently below the lower limit of nor...
...H is persistently below the lower limit of...
...If SH is to be treated, the treatment shoul...
...linical Hyperthyroidism: When to TreatHaving trou...
Pregna...
...diagnosis of hyperthyroidism in pre...
...ransient hCG-mediated TSH suppressi...
...erapy should be used for overt hyperthyroidism d...
...n women who develop hyperthyroidism during thei...
92. The ATA suggests that women with hype...
...omen with hyperthyroidism caused by...
...A suggests that women who are trea...
...he ATA suggests that a woman who tests positive fo...
...A suggests that the physician contac...
...ests that women in early pregnancy who have a...
...king PTU during the 1st trimester of pregna...
99. GD during pregnancy should be treated w...
...egnancy is a relative contraindication to thy...
...yroidectomy is necessary for the treatmen...
...oidectomy is necessary for the treatment of...
...ts who were treated with RAI or thyr...
...Patients receiving ATD for GD whe...
...nts with elevated TRAb levels at 18–22 week...
...tpartum Thyroiditis...
...In women developing thyrotoxicosis...
...n with symptomatic thyrotoxicosis from postpartum...
...n pregnant women diagnosed with hypert...
Table 12. Summary of Recommendations Concerning Ma...
Other Conditions
...ther Conditi...
...rug-Associated Thyroto...
...Causes of Drug-Associated ThyrotoxicosisHaving...
...nts taking medications known to cause thyroto...
...e-induced Hyperthyroidi...
...ine administration of ATDs before iodinated...
...renergic blocking agents alone or in...
...one-induced Thyrotoxicosis (AIT)...
...e ATA suggests monitoring thyroid...
...ecision to stop amiodarone in the sett...
...n clinically stable patients with AI...
...hould be used to treat overt thyrotoxicosis in pat...
...Combined ATD and corticosteroid therapy should be...
...ients with AIT who are unresponsiv...
...Suggested Approach to the Management...
...uctive Thyroiditis...
...cute Thyroiditis...
...Patients with mild symptomatic subacute thyro...
...inless Thyroiditi...
...Patients with symptomatic thyrotoxicosis due t...
...cute Thyroidit...
...thyroiditis should be treated wit...
Unusual Causes of Thyrotox...
...sual Causes of ThyrotoxicosisHaving trou...
...H-Secreting Pituitary Tu...
...nosis of a TSH-secreting pituitary adenom...
...with TSH-secreting pituitary adenomas should...
...ruma Ovar...
...23. Patients with struma ovarii should be treate...
...oriocarcino...
.... Treatment of hyperthyroidism due to ch...
Appendix
...pendix...
...le 15. Theoretical Projections of Cancer I...