🧭 When to suspect

Thyrotoxicosis is the clinical syndrome of excess circulating thyroid hormone.

• Hyperthyroidism refers specifically to thyrotoxicosis caused by overproduction of hormone by the thyroid gland itself (Graves' disease, toxic nodular goitre).

• A self-limiting thyroiditis leaks preformed hormone.

Separating true hyperthyroidism from thyroiditis is the central task, because it decides whether the patient needs an antithyroid drug or simply symptom control.

Suspect it in anyone with the classic “sped-up” hypermetabolic and adrenergic picture:

• Heat intolerance, sweating, anxiety, irritability.

• Palpitations and a fine tremor.

• Diarrhoea and weight loss despite a normal or increased appetite.

• In women, oligomenorrhoea or amenorrhoea is common.

Eye symptoms – a gritty sensation, watering, redness, or proptosis – point strongly to Graves' disease.

Confirm thyrotoxicosis biochemically, never miss thyroid storm, and refer every new case for specialist assessment while starting symptom relief in the meantime.

Common cause	Pointers in primary care
Graves' disease	• Commonest cause • Diffuse goitre, eye signs (proptosis, lid retraction), positive thyroid-stimulating hormone (TSH) receptor antibodies (TRAb) • Typically younger women • Smoking worsens the eye disease
Toxic multinodular goitre or toxic adenoma	• Older patients • Nodular or single-nodule goitre, no eye signs, TRAb negative
Thyroiditis – subacute (De Quervain's), postpartum, or silent	Self-limiting release of preformed hormone. • Often follows a viral illness (painful, tender goitre, raised ESR/CRP) or pregnancy (within ~12 months postpartum). • Needs symptom control only – not an antithyroid drug.
Drug-induced – amiodarone, iodine/contrast, lithium	• Check the drug history • Amiodarone causes both hyper- and hypothyroidism and needs specialist input

Source: NICE NG145

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Inside the full topic 🔒 History🔒 Red Flags🔒 Examination🔒 Patient Explanation🔒 Investigations🔒 Management🔒 Non-pharmacological Treatment🔒 Pharmacological Treatment🔒 Pregnancy, Preconception & Contraception🔒 Special Notes🔒 Referral Pathways🔒 Take Home Messages

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