Francis J. Thyroid. Cetinay P, Bircan R, West JM. Incidence, clinical characteristics and outcome of congestive heart failure as the initial presentation in patients with primary hyperthyroidism. Graves’ disease is defined as an autoimmune thyroid disorder with an unknown etiology. De Martino E, Grillo HC, Thyroid storm. Van den Bosch J, It is important to remember that other nodules in your thyroid that are not toxic may influence which treatment option is best. Kung AW, Braverman LE. Avenell A, Olesen JB, 2. For supporting citations and to search Choosing Wisely recommendations relevant to primary care, see https://www.aafp.org/afp/recommendations/search.htm. Burch HB, Pituitary. Once the diagnosis of hyperthyroidism is made, a thyroid scan can be performed. 2012;97(2):499–506. Copyright © 2016 by the American Academy of Family Physicians. 8. Sibling recurrence risk in autoimmune thyroid disease. 2011;57(1):122–127. Lublinghoff J, Once free T4 and total T3 levels normalize, they should be monitored every three months. Kumar and Clark’s Clinical Medicine. A toxic nodule appears a single area of overactivity and a toxic multinodular goiter has multiple areas. Surgery for toxic multinodular goiter typically involves removal of the entire thyroid, especially if nodules are present on both sides of the thyroid or the thyroid is enlarged and causing pressure in the neck or difficulty with swallowing. The diagnostic workup for hyperthyroidism includes measuring thyroid-stimulating hormone, free thyroxine (T4), and total triiodothyronine (T3) levels to determine the presence and severity of the condition, as well as radioactive iodine uptake and scan of the thyroid gland to determine the cause. Therefore, there is an increase in the thyroxin level in the blood. The physician should determine whether the medication may be discontinued safely or replaced with a different medication. et al. 2011;121(1):68–76. Ozen C, Do not routinely order a thyroid ultrasound in patients with abnormal thyroid function tests if there is no palpable abnormality of the thyroid gland. 32. All patients with a multinodular goiter should be screened annually by measurement of serum TSH. The epidemiology of thyroid disease. Persani L. Adapted with permission from Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. Get Permissions, Access the latest issue of American Family Physician. Pregnancy should be ruled out within 48 hours before radioactive iodine ablation and avoided for six months thereafter.1 A thionamide should be discontinued at least five days before the treatment but can be restarted three to five days after to maintain control of thyroid function, because it may take up to 12 weeks to achieve the full effect of radioactive iodine. Mendu DR, Mol Cell Endocrinol. Gaitonde DY. Genetics and phenomics of inherited and sporadic non-autoimmune hyperthyroidism. Nat Rev Endocrinol. 37. Lau CP, 11. Itoh K, Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists [published corrections appear in Thyroid.

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