From the Guidelines
Hyperthyroidism typically presents in several main forms, including Graves' disease, toxic multinodular goiter, toxic adenoma, thyroiditis, and exogenous hyperthyroidism, each with distinct clinical features and treatment approaches. The most common causes of hyperthyroidism include Graves disease, Hashimoto thyroiditis, and functional thyroid nodules, as noted in the study by 1. Risk factors for a low TSH level, indicative of hyperthyroidism, include female sex, advancing age, black race, low iodine intake, personal or family history of thyroid disease, and ingestion of iodine-containing drugs, such as amiodarone 1.
Main Forms of Hyperthyroidism
- Graves' disease: characterized by diffuse goiter, ophthalmopathy (bulging eyes), and occasionally dermopathy (pretibial myxedema)
- Toxic multinodular goiter: presents with an enlarged, nodular thyroid and symptoms developing gradually over time, often in older patients
- Toxic adenoma: involves a single hyperfunctioning nodule causing thyrotoxicosis
- Thyroiditis: causes transient hyperthyroidism due to inflammation and release of stored thyroid hormone, including subacute, silent, and postpartum forms
- Exogenous hyperthyroidism: occurs from excessive thyroid hormone medication
Clinical Features and Treatment
Common symptoms across all forms include heat intolerance, weight loss despite increased appetite, palpitations, tremors, anxiety, fatigue, increased sweating, and menstrual irregularities. Physical examination may reveal tachycardia, hypertension, fine tremor, hyperreflexia, and warm, moist skin. Laboratory findings typically show suppressed TSH and elevated free T4 and/or T3 levels. The specific form of hyperthyroidism guides treatment approaches, which may include antithyroid medications (such as methimazole) or nonreversible thyroid ablation therapy (for example, radioactive iodine or surgery), as recommended by 1. Treatment is generally recommended for patients with a TSH level that is undetectable or less than 0.1 mIU/L, particularly those with overt Graves disease or nodular thyroid disease.
From the Research
Main Forms of Hyperthyroidism Presentation
The main forms of hyperthyroidism presentation include:
- Graves' disease (GD) 2, 3, 4, 5
- Toxic multinodular goiter 2, 3, 4, 5, 6
- Toxic adenoma 2, 3, 4, 5
- Thyroiditis 3
- Side effects of certain medications 3
Characteristics of Each Form
- Graves' disease: an autoimmune disease that causes the thyroid gland to produce excess thyroid hormones 2, 3, 4, 5
- Toxic multinodular goiter: a condition where multiple nodules in the thyroid gland produce excess thyroid hormones 2, 3, 4, 5, 6
- Toxic adenoma: a condition where a single nodule in the thyroid gland produces excess thyroid hormones 2, 3, 4, 5
- Thyroiditis: inflammation of the thyroid gland that can cause hyperthyroidism 3
- Side effects of certain medications: certain medications can cause hyperthyroidism as a side effect 3
Diagnosis and Treatment
Diagnosis of hyperthyroidism is based on clinical findings, biochemical tests, and imaging techniques 2, 3, 4, 5 Treatment options include anti-thyroid medications, radioactive iodine, and surgery 2, 3, 4, 5