‘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

  Examn Check for possible side effects incl. sore throats Thyroid function Antibodies Bone age Thyroid U/S Other
Diagnosis and visit 1 *   * * *   *isotope scan
Visit 2: 4 weeks * * *        
Visit 3: 6 weeks * * *        
Visit 4: 8 weeks * * *        
Visit 5: 12 weeks * * *        
Visit 6: 6 months * * *        
Visit 7: 9 months * * *        
Visit 8: 12 months * * *        
Visit 9: 15 months * * *        
Visit 10:18 months * * *        
Visit 11:21 months * * *        
Visit 12:24 months * * *        
Visit 13:27 months * * *        
Visit 14:30 months * * *        
Visit 15:33 months * * *        
Visit 16:36 months * * * * * *  
Visit 17:48 months * * * * * *