Hyperthyroidism: Diagnosis and Treatment

 


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Am Fam Physician. 2016 Mar 1;93(5):363-370.

  Patient information: See related handout on overactive thyroid gland (hyperthyroidism), written by the author of this article.

  Related letter: Hyperthyroidism Caused by Thyroid Hormone Therapy

Author disclosure: No relevant financial affiliations.

Hyperthyroidism is an excessive concentration of thyroid hormones in tissues caused by increased synthesis of thyroid hormones, excessive release of preformed thyroid hormones, or an endogenous or exogenous extrathyroidal source. The most common causes of an excessive production of thyroid hormones are Graves disease, toxic multinodular goiter, and toxic adenoma. The most common cause of an excessive passive release of thyroid hormones is painless (silent) thyroiditis, although its clinical presentation is the same as with other causes. Hyperthyroidism caused by overproduction of thyroid hormones can be treated with antithyroid medications (methimazole and propylthiouracil), radioactive iodine ablation of the thyroid gland, or surgical thyroidectomy. Radioactive iodine ablation is the most widely used treatment in the United States. The choice of treatment depends on the underlying diagnosis, the presence of contraindications to a particular treatment modality, the severity of hyperthyroidism, and the patient's preference.

Hyperthyroidism is an excessive concentration of thyroid hormones in tissues causing a characteristic clinical state. In the United States, the overall prevalence of hyperthyroidism is 1.2%, and the prevalences of overt hyperthyroidism and subclinical hyperthyroidism are 0.5% and 0.7%, respectively.1

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

The choice of treatment modality for hyperthyroidism caused by overproduction of thyroid hormones depends on the patient's age, symptoms, comorbidities, and preference.

C

25, 26

The diagnostic workup for hyperthyroidism includes measuring thyroid-stimulating hormone, free thyroxine (T4), and total triiodothyronine (T3) levels to determine the presence and severity of the condition, as well as radioactive iodine uptake and scan of the thyroid gland to determine the cause.

C

20, 21

Methimazole (Tapazole) is the preferred antithyroid medication except in the first trimester of pregnancy and in patients with an adverse reaction to the medication.

B

26


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

The choice of treatment modality for hyperthyroidism caused by overproduction of thyroid hormones depends on the patient's age, symptoms, comorbidities, and preference.

C

25, 26

The diagnostic workup for hyperthyroidism includes measuring thyroid-stimulating hormone, free thyroxine (T4), and total triiodothyronine (T3) levels to determine the presence and severity of the condition, as well as radioactive iodine uptake and scan of the thyroid gland to determine the cause.

C

20, 21

Methimazole (Tapazole) is the preferred antithyroid medication except in the first trimester of pregnancy and in patients with an adverse reaction to the medication.

B

26


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

View/Print Table

BEST PRACTICES IN ENDOCRINOLOGY: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN

RecommendationSponsoring organization

Do not order multiple tests in the initial evaluation of a patient with suspected thyroid disease. Order TSH, and if abnormal, follow up with additional evaluation or treatment depending on the findings.

American Society for Clinical Pathology

Do not routinely order a thyroid ultrasound in patients with abnormal thyroid function tests if there is no palpable abnormality of the thyroid gland.

The Endocrine Society/American Association of Clinical Endocrinologists


TSH = thyroid-stimulating hormone.

Source: For more information on the Choosing Wisely Campaign, see http://www.choosingwisely.org. For supporting citations and to search Choosing Wisely recommendations relevant to primary care, see http://www.aafp.org/afp/recommendations/search.htm.

BEST PRACTICES IN ENDOCRINOLOGY: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN

RecommendationSponsoring organization

Do not order multiple tests in the initial evaluation of a patient with suspected thyroid disease. Order TSH, and if abnormal, follow up with additional evaluation or treatment depending on the findings.

American Society for Clinical Pathology

Do not routinely order a thyroid ultrasound in patients with abnormal thyroid function tests if there is no palpable abnormality of the thyroid gland.

The Endocrine Society/American Association of Clinical Endocrinologists


TSH = thyroid-stimulating hormone.

Source: For more information on the Choosing Wisely Campaign, see http://www.choosingwisely.org

The Author

IGOR KRAVETS, MD, is an assistant professor of medicine in the endocrinology division of Stony Brook (NY) University School of Medicine.

Address correspondence to Igor Kravets, MD, Stony Brook University School of Medicine, 101 Nicolls Rd., HSC T-15, Rm. 060, Stony Brook, NY 11733 (e-mail: igor.kravets@stonybrookmedicine.edu). Reprints are not available from the author.

Author disclosure: No relevant financial affiliations.

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