Thyrotoxicosis is common and can present in numerous ways with patients exhibiting a myriad of symptoms and signs. It affects around 1 in 2000 people annually in Europe1. The thyroid gland produces two thyroid hormones - thyroxine (T4) and triiodothyronine (T3). Thyroxine is inactive and is converted by the tissues and organs that need it into tri-iodothyronine. In health, the production of these thyroid hormones is tightly regulated by the secretion of thyroid stimulating hormone (TSH; thyrotropin) from the pituitary gland. The term ‘thyrotoxicosis’ refers to the clinical manifestations of hyperthyroidism.

[download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]

References

1. Garmendia Madariaga A et al; The incidence and prevalence of thyroid dysfunction in Europe: a meta-analysis. J Clin Endocrinol Metab 2014; 99(3):923-31.
2. Vaidya B and Pearce SHS; Diagnosis and management of thyrotoxicosis. BMJ 2014; 349:g5218.
3. Ross DS et al; American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid 2016; 26(10):1343-1421.
4. Burch HB and Cooper DS; Management of Graves’ Disease: A Review. JAMA 2015; 314(23):2544-54.
5. Smith TJ and Hegedüs L; Graves’ Disease. N Engl J Med 2016; 375(16):1552-1565.
6. Mitchell AL et al; Diagnosis of Graves’ orbitopathy (DiaGO): results of a pilot study to assess the utility of an office tool for practicing endocrinologists. J Clin Endocrinol Metab 2015; 100(3):E458-62.
7. Mitchell AL and Pearce SHS; How should we treat patients with low serum thyrotropin concentrations? Clin Endocrinol 2010; 72(3):292-6.
8. Biondi B et al; The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism. Eur Thyroid J 2015; 4(3):149-63.
9. Watanabe N et al; Antithyroid-drug induced hematopoietic damage: a retrospective cohort study of agranulocytosis and pancytopenia involving 50,385 patients with Graves’ disease. JCEM 2012; 97:E49-53.
10. Carle A et al; Management of Endocrine Disease: Subclinical thyrotoxicosis: prevalence, causes and choice of therapy. EJE 2017; 176:325-337.
11. NICE CKS Hyperthyroidism June 2016 Accessed via www.cks.nice.org.uk [November 2017].
12. Pearce EN et al; Thyroiditis. N Engl J Med 2003; 348(26):2646- 2655.
13. Laurberg P et al; Management of Graves’ hyperthyroidism in pregnancy: Focus on both maternal and foetal thyroid function, and caution against surgical thyroidectomy in pregnancy. Eur Jour Endocrinol 2009; 160(1):1-8.
14. Rivkees SA and Mandel SJ; Thyroid disease in pregnancy. Horm Res Paediatr 2011; 76 (supp.1):91-96.