Hyperthyroidism
A condition where the thyroid gland produces too much thyroid hormone (T3 and T4), leading
to an overactive metabolism.
The primary complaints include:
● Unintentional weight loss of [#] lbs over the past [weeks/months] despite unchanged
or increased appetite
● Heat intolerance and feeling excessively warm compared to others
● Increased sweating, especially at night
● Palpitations or awareness of a rapid heartbeat
● Fatigue, nervousness, or restlessness
● Tremors
● Frequent bowel movements or diarrhea
● Menstrual irregularities
The patient also reports:
● Anxiety or irritability
● Sleep disturbances or insomnia
● Shortness of breath or exertional dyspnea
● Muscle weakness, especially in the proximal limbs
● Neck fullness, pressure, or visible neck swelling (goiter)
Physical Exam:
● Skin: warm, moist, pretibial myxedema (GD only)
● HEENT: fine, thin or brittle hair.
● Endocrine: hyperhidrosis, heat intolerance, goiter, gynecomastia, and spider angiomata
● Cardiovascular: tachycardia, atrial fibrillation, cardiomegaly
● Musculoskeletal: fractures
● Neurologic: tremor, proximal muscle weakness, anxiety and lability, brisk deep tendon
reflexes
Diagnostic:
● TSH: Suppressed or low.
● Free T4 & T3: Elevated levels confirm hyperthyroidism.
● Thyroid Antibodies: (e.g., TSI in Graves' disease).
● Radioactive Iodine Uptake (RAIU): High uptake in Graves' disease, lower in thyroiditis.
Thyroid Ultrasound: Identifies nodules or inflammation.
Management:
● Methimazole 10 to 15 mg BID or QD
● PTU 100 to 150 mg PO TID. (preferred in thyroid storm and 1st trimester of pregnancy)
● Propranolol 10 - 40 mg QD Controls tremors, palpitations, anxiety. Taper once euthyroid.
, ● Repeat thyroid tests q3mo, CBC, and liver function tests (LFTs) on thioamide therapy;
continue therapy with thioamides for 12 to 18 months.
Subclinical Hyperthyroidism
- Deceased TSH < 0.01
- T4 and T3 normal
Management:
● Stop Synthroid and restart in low dose
● Repeated Lab in 3 months
● Consider TRab level and/or perform radioactive iodine thyroid scan and uptake
○ US thyroid, if nodule > 2.5cm, then biopsy
Thyroid Storm
Thyroid Storm is a rare, life-threatening condition characterized by an extreme overproduction of
thyroid hormones, typically in patients with untreated or poorly managed hyperthyroidism,
particularly Graves' disease. This hypermetabolic state can lead to severe symptoms and multi-
organ failure.
Key Characteristics:
● High fever (often over 104°F)
● Severe tachycardia (rapid heart rate)
● Hypertension initially, followed by potential hypotension and shock Agitation, delirium, or
even coma
● Vomiting, diarrhea, and jaundice (indicating liver dysfunction)
Causes: Often triggered by acute stress events in individuals with hyperthyroidism.
Triggers: Include surgery, severe infections, trauma, certain medications (e.g., stopping
antithyroid drugs abruptly)
Management:
● Referral and hospitalization in an intensive care setting
● Antithyroid medications (e.g., propylthiouracil or methimazole) to reduce hormone
production Beta-blockers to manage heart rate and prevent complications
● Supportive care for fever and fluid balance
● Prompt recognition and treatment are critical, as thyroid storm can be fatal if not
managed quickly.
Thyroid Nodules and Goiter
Thyroid Nodules: lesion in thyroid
A condition where the thyroid gland produces too much thyroid hormone (T3 and T4), leading
to an overactive metabolism.
The primary complaints include:
● Unintentional weight loss of [#] lbs over the past [weeks/months] despite unchanged
or increased appetite
● Heat intolerance and feeling excessively warm compared to others
● Increased sweating, especially at night
● Palpitations or awareness of a rapid heartbeat
● Fatigue, nervousness, or restlessness
● Tremors
● Frequent bowel movements or diarrhea
● Menstrual irregularities
The patient also reports:
● Anxiety or irritability
● Sleep disturbances or insomnia
● Shortness of breath or exertional dyspnea
● Muscle weakness, especially in the proximal limbs
● Neck fullness, pressure, or visible neck swelling (goiter)
Physical Exam:
● Skin: warm, moist, pretibial myxedema (GD only)
● HEENT: fine, thin or brittle hair.
● Endocrine: hyperhidrosis, heat intolerance, goiter, gynecomastia, and spider angiomata
● Cardiovascular: tachycardia, atrial fibrillation, cardiomegaly
● Musculoskeletal: fractures
● Neurologic: tremor, proximal muscle weakness, anxiety and lability, brisk deep tendon
reflexes
Diagnostic:
● TSH: Suppressed or low.
● Free T4 & T3: Elevated levels confirm hyperthyroidism.
● Thyroid Antibodies: (e.g., TSI in Graves' disease).
● Radioactive Iodine Uptake (RAIU): High uptake in Graves' disease, lower in thyroiditis.
Thyroid Ultrasound: Identifies nodules or inflammation.
Management:
● Methimazole 10 to 15 mg BID or QD
● PTU 100 to 150 mg PO TID. (preferred in thyroid storm and 1st trimester of pregnancy)
● Propranolol 10 - 40 mg QD Controls tremors, palpitations, anxiety. Taper once euthyroid.
, ● Repeat thyroid tests q3mo, CBC, and liver function tests (LFTs) on thioamide therapy;
continue therapy with thioamides for 12 to 18 months.
Subclinical Hyperthyroidism
- Deceased TSH < 0.01
- T4 and T3 normal
Management:
● Stop Synthroid and restart in low dose
● Repeated Lab in 3 months
● Consider TRab level and/or perform radioactive iodine thyroid scan and uptake
○ US thyroid, if nodule > 2.5cm, then biopsy
Thyroid Storm
Thyroid Storm is a rare, life-threatening condition characterized by an extreme overproduction of
thyroid hormones, typically in patients with untreated or poorly managed hyperthyroidism,
particularly Graves' disease. This hypermetabolic state can lead to severe symptoms and multi-
organ failure.
Key Characteristics:
● High fever (often over 104°F)
● Severe tachycardia (rapid heart rate)
● Hypertension initially, followed by potential hypotension and shock Agitation, delirium, or
even coma
● Vomiting, diarrhea, and jaundice (indicating liver dysfunction)
Causes: Often triggered by acute stress events in individuals with hyperthyroidism.
Triggers: Include surgery, severe infections, trauma, certain medications (e.g., stopping
antithyroid drugs abruptly)
Management:
● Referral and hospitalization in an intensive care setting
● Antithyroid medications (e.g., propylthiouracil or methimazole) to reduce hormone
production Beta-blockers to manage heart rate and prevent complications
● Supportive care for fever and fluid balance
● Prompt recognition and treatment are critical, as thyroid storm can be fatal if not
managed quickly.
Thyroid Nodules and Goiter
Thyroid Nodules: lesion in thyroid
