Hyperthyroidism

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Hyperthyroidism and thyrotoxicosis are often used interchangeably. Graves&s; disease (GD) is the commonest cause of hyperthyroidism followed by toxic nodular goiter. Patients presenting as goiter with clinical features of hyperthyroidism are to be carefully evaluated with biochemically with thyroid-stimulating hormone (TSH), free thyroxine (fT4) and radionuclide scan (technetium-99/iodine-123). Those with GD also have raised thyroid receptor–stimulating antibody levels. Patients with hyperthyroidism are simultaneously evaluated for eye disease and managed accordingly. Initial treatment is rendering patient euthyroid using antithyroid drugs (ATDs), followed by definitive therapy in the form of radioactive iodine (RAI) ablation or surgery. Surgery performed by high-volume thyroid surgeon in the form of near-total or total thyroidectomy reduces postoperative complications as well as recurrences. Those candidates not eligible or willing for definitive therapy can be managed with ablative therapies with almost similar outcomes as RAI. Thyrotoxicosis without hyperthyroidism can be due to thyroiditis, drug induces, exogenous causes. Prompt evaluation and careful management is mandatory.

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