Hyperthyroidism

Differential Diagnosis

• Graves disease (autoimmune)
• Thyroiditis
  • Viral (painful, subacute)
  • Autoimmune
    • Transient (painless)
    • Post-partum thyroiditis (painless)
• Toxic nodule
• Toxic multinodular goitre
• Iatrogenic
  • Amiodarone
  • Lithium

Clinical Presentation

Biochemical

• Laboratory dysfunction only

Subclinical

• Progresses to symptomatic hyperthyroidism in 25% by 5 years

Clinical

• History
  • Heat intolerance
  • Weight loss
  • Anxiety
  • Emotional ability
  • Weakness
  • Tremor
  • Palpitations
  • Increased perspiration
  • Distractibility
• Signs & Symptoms
  • Atrial fibrillation

Graves Disease

• Signs and symptoms of hyperthyroidism
• Diffuse goitre
• Proptosis, palpebral swelling
• Diffuse dermopathy

Investigations

• Labs
  • TSH; if low, repeat and add free T3 and free T4
• Imaging
• Other