Hyperthyroidism

Hyperthyroid workup.PNG

Differential Diagnosis

  • Sub-clinical

  • Graves disease

    • Diplopia, blurred vision, exophthalmos, goiter

    • Positive TPO antibodies and homogeneous radioactive iodine uptake

    • Methimazole vs. thyroidectomy vs. radioiodine ablation

  • Toxic multinodular goiter

    • Elderly patient with iodine deficient diet

    • Radioactive iodine scan: Multiple nodules with high uptake

    • Treatment: Propranolol, methimazole

  • Transient (painless) thyroiditis

    • Thyroiditis symptoms with normal physical exam

    • TSH persistently between 0.1 and 0.4 mIU/L

    • Rule out iatrogenic etiology (amiodarone, lithium)

  • Sub-acute (De Quervain) thyroiditis

    • Painful thyroid s/p febrile illness +/- rash

    • TSH between 0.1 and 0.4 mIU/L

    • Naproxen for pain and repeat testing at 6 weeks

Alternative Diagnosis: See thyroid nodule evaluation