Hyperthyroidism

🔍 When to Suspect

Symptoms of a sped-up metabolism: heat intolerance, anxiety, irritability, palpitations, and unexplained weight loss despite a normal or increased appetite; eye symptoms suggest Graves' disease

From the full topic in The Ocean Library: Hyperthyroidism

🧭 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

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