Other causes of thyrotoxicosis

‘Hashitoxicosis’ may be indistinguishable initially from Graves disease biochemically and should be treated is the same way. A Technetium (Tc99m) or iodine (123I) uptake scan will show reduced uptake rather than increased uptake.

TPO and thyroglobulin antibodies may be present in both diseases, but a raised TRAb titre is indicative of Graves’ disease.

‘Hot thyroid nodules’ are practically always benign (non-cancerous). Diagnosis is by ultrasound and isotope scan. Treatment options are primarily surgical (partial lobectomy) or Radioiodine.

Thyroid storm (thyrotoxic crisis) ¹³

This presents with fever, sweating, tachycardia, hypertension leading to high output cardiac failure. Patients may also have seizures.

Thyroid storm requires emergency In-patient Care by an experienced endocrinologist with:

• intravenous administration of fluids.
• antithyroid medication – large doses of propylthiouracil +/- iodide.
• propranolol to minimise the adrenergic effects.
• hydrocortisone (high risk of adrenal insufficiency).

Also treat the precipitating factor of the crisis such as infection

Suggested follow up and investigations

Based on BSPED trial protocol ⁷