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Hyperthyroidism Evaluation Algorithm

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Hyperthyroidism evaluation

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Evaluation of Hyperthyroidism in the clinic

You will need the following parameters - Free T4, Free T3, TSH, Radioactive iodine uptake, and scan (I-123)

Review free T4 and TSH

High FT4 and Low TSH

High FT4 and High TSH

Normal FT4 and low TSH

Review Free T3

High Free T3

Low Free T3

Normal Free T3

Physical Examination findings

Thyroid Eye Signs with/without goiter

No Eye Signs or Goiter (or otherwise small goiter)

No Eye Signs (uninodular or multinodular thyroid)

Radioactive Iodine Uptake and Scan (I-123)

High Uptake

Low Uptake

Measure Thyroglobulin

High Thyroglobulin

Low Thyroglobulin

Low Thyroglobulin

Exogenous Thyroid Hormone (prescribed or factitious)

Radioactive Iodine Uptake Pattern

Diffuse Uptake Pattern

Nodular Uptake Pattern

Diagnosis

Graves Disease

Diagnoses

Solitary Toxic Nodule

Toxic Multinodular Goiter

High Thyroglobulin

Subacute thyroiditis

Silent thyroiditis

Graves Disease or Toxic nodular goiter (in the setting of iodine overload)

Struma Ovarii

Diagnoses

TSH-secreting pituitary adenoma (TSHoma)

Thyroid Hormone Resistance

Diagnoses

Levothyroxine induced subclinical hyperthyroidism

Mild Graves Disease

Mild Toxic Multinodular Goiter

First Trimester of Pregnancy

Nonthyroidal illness

Diagnoses

Sick Euthyroid Syndrome

Corticosteroids

Dopamine

References

Kravets I. Hyperthyroidism: Diagnosis and Treatment. Am Fam Physician. 2016 Mar 1;93(5):363-70. PMID: 26926973.

About the Author MyEndoConsult

The MyEndoconsult Team. A group of physicians dedicated to endocrinology and internal medicine education.

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