Clinical Presentation and Diagnosis of Hyperthyroidism

Symptoms

• Nervousness

• Increased perspiration

• Heat intolerance

• Hyperactivity, irritability

• Palpitations

• Appetite change (usually increased)

• Weight change (usually weight loss)

• Menstrual disturbances (often oligomenorrhea)

Signs

• Hyperactivity

• Tachycardia

• Atrial fibrillation (especially in elderly)

• Hyper-reflexia

• Ophthalmopathy, dermopathy (Graves' disease)

• Muscle weakness Screening/Diagnosis

• Low TSH level (less than 0.5 milliunit/L) will signify thyrotoxicosis.

• Free T4 is elevated in overt hyperthyroidism.

• Increased radioiodine uptake in the thyroid indicates increased hormone production by the thyroid gland.

• Almost all patients with Graves' disease will have positive TSHR-SAbs and positive anti-TPOAbs.

From Refs. 36-38.

Table 44-6 Causes of Thyrotoxicosis

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