Hyperthyroidism

Exam Cram

• Hyperthyroidism is a sign of high active thyroid hormone hormone (T4)

• Presentation: anxiety, tremor, heat intolerance, tachycardia (atrial fibrillation)

• Diagnosis: high T3

• Management: as per underlying cause

Causes

1. Graves Disease

   • TSH receptor antibodies (TRABs) positive

   • Thyroid eye disease

2. Thyroiditis

   • Post infective hyper then hypothyroidism

3. Toxic Multinodular (TMN) Goitre 

4. Adenoma: toxic thyroid nodule

5. TSH pituitary adenoma

6. Post-partum thyroiditis

   • beta-HCG has thyroid action

   • Presents within couple months of birth

   • Tender thyroid gland

   • Nil TPO but 40% progress to Hashimoto's

7. Drug induced

   • Amiodarone

     • Management: steroids

8. Neuroendocrine tumour secreting TSH

Subclinical Hyperthyroidism

Presentation

• Incidental finding

Investigations

• T3/4 within normal range, low TSH (TSH compensating to reduce T4)

• TPO antibodies: negative

Management

• Repeat thyroid function tests every 3 years (nil management required)

Resources and References

1. https://cks.nice.org.uk/topics/hyperthyroidism/background-information/causes/

Written in 2025