GPAtlas🧭 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). Separating true hyperthyroidism from a self-limiting thyroiditis – which leaks preformed hormone – 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, 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.
The key primary-care skills are threefold: 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 TSH receptor antibodies (TRAb); typically younger women. Smoking worsens the eye disease. |
| Toxic multinodular goitre / 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
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.