Hyperthyroidism

Extract

• In a hyperthyroid patient, TSH concentration is below reference range (often unmeasurable), and free T4 and/or free T3 concentrations are increased.
• As a general rule, patients with hyperthyroidism are referred to a specialist in internal medicine or an endocrinologist for assessment.
• Start a beta-blocker and also antithyroid medication already at referral to a specialist when the diagnosis of hyperthyroidism is clear. Remember to inform the patient concerning the risk of agranulocytosis associated with antithyroid medication.
• Patients with thyroid eye disease (in Basedow's [Grave's] disease only Graves’ ophthalmopathy1) or with pregnancy-induced hyperthyroidism are promptly referred to a specialist.
• Hyperthyroidism is always treated. In uncertain cases, begin with a beta-blocker only.
• Depletion of hormone storages that is associated with an inflammatory state is not treated with antithyroid drugs (e.g subacute thyroiditis Subacute thyroiditis2).
• The thyroid gland is palpated in order to estimate its size, whereas ultrasonography has no place in the diagnostics of hyperthyroidism.

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Adrenergic beta-Antagonists, Agranulocytosis, Antithyroid Agents, Carbimazole, Child, E05*, E06.2, Endocrinology, Goiter, Nodular, Graves Disease, Hashimoto disease, subacute, Hyperthyroidism, Hypothyroidism, Internal medicine, Iodine Radioisotopes, Leukocytes, Metoprolol, Pregnancy, Propranolol, Surgical Procedures, Operative, T4 free, Thyroiditis, Subacute, Thyrotropin, Thyroxine, euthyroidism, follow-up test, ocular syndrome, radiation thyroiditis, toxic nodular goiter