Summary
Diagnosis
Based on clinical findings and suppressed TSH, raised thyroid hormones.
Investigations
- First Line; TSH, free T4, total T3 (or free t3).
- Second line investigations optional, but preferred; TRAb, USS thyroid, Isotope scan thyroid.
Treatment
First line therapy – Drug treatment.
- Usually Start with Carbimazole 0.75mg/kg/day.
- 2 variations in drug treatment; ‘block and replace’ or titration. Continue for 36 months. Stop then reassess.
- Add Propranolol initially if significant autonomic symptoms/signs.
Second line (treatment failure or relapse after 36 months): – Radioiodine therapy or surgery requiring referral to regional centre.
Eye disease– refer to ophthalmologist.