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Griffin Bullock, Lauren Waskowicz


  • Excess thyroid hormone caused by increased synthesis, excessive release of preformed thyroid hormone or endogenous/exogenous release of hormone from extrathyroid source
  • Low TSH and High T4 and/or T3 (primary): Graves’, Toxic goiter, TSH-producing adenoma, hyperemesis gravidarum, subacute granulomatous thyroiditis, amiodarone, radiation, excessive replacement, struma ovarii
  • Low TSH/Normal T4 and T3: Subclinical hyperthyroidism, central hypothyroidism, non-thyroidal illness, recovery from hyperthyroidism, pregnancy (physiologic)
  • Subclinical Hyperthyroidism: repeat testing to verify abnormality is not transient


  • Sx: Heat intolerance, tremor, palpitations, anxiety, weight loss (w/ normal/increased appetite), increased BM frequency, SOB
  • Physical Exam: Goiter, tachycardia/Afib, stare/lid lag, marked muscle weakness (rare presentation of thyrotoxic periodic paralysis), hyperreflexia
  • Graves Specific Findings: proptosis/exophthalmos, infiltrative dermopathy (localized or pretibial myxedema)


  • TSH, free T4, free T3 (only T3 or T4 may be elevated, though both often are)
    • Biotin affects assay, causes falsely ↓ TSH and falsely ↑ FT4/FT3
  • CBC: may have a normocytic anemia due to increased plasma volume

Hyperthyroidism flowchart


  • Methimazole, PTU, beta blockers, radioiodine ablation, surgery
  • Endocrine referral