Thyroid inferno

The key to uncovering the etiology of hyperthyroidism lies in a careful history and physical examination. Autoimmune markers provide additive information, but should not solely be used to make a diagnosis. Concern has been raised that the overzealous use of thyroid ultrasound, following abnormal thyroid function tests, diverts attention from the workup of the biochemical abnormality to the workup of an incidentally found thyroid nodule. If further imaging is needed, the use ofathyroidscanhas been suggestedbythe Endocrine Society and the American Association of Clinical Endocrinologists. However, in certain scenarios, this may be contraindicated. We present the case of a 28-year-old female with hyperthyroidism, as aplatform to discuss an important clinical sign present on Doppler ultrasound of the thyroid. By recognizing the clinical information gained from a Doppler ultrasound, physicians can avoid additional invasive workup and apply the use of ultrasound where most appropriate.