Hyperthyroidism: aetiology, pathogenesis, diagnosis, management, complications, and prognosis

Area of Science:

• Endocrinology
• Internal Medicine
• Thyroidology

Background:

• Hyperthyroidism affects 0.2-1.3% globally.
• Diagnosis involves biochemical tests (low TSH, high FT4/FT3) and etiological investigation using antibodies, ultrasound, and scintigraphy.
• Graves' disease (70%) and toxic nodular goitre (16%) are primary causes, with others including thyroiditis and drug-induced thyrotoxicosis.

Purpose of the Study:

• To provide an overview of hyperthyroidism diagnosis and management.
• To discuss disease-specific recommendations and treatment strategies.
• To highlight special considerations for specific patient populations and emerging treatments.

Main Methods:

• Review of current diagnostic tools including biochemical assays and imaging.
• Analysis of treatment modalities for different hyperthyroid etiologies.
• Discussion of risk factors for recurrence and long-term management strategies.

Main Results:

• Graves' hyperthyroidism is often treated with antithyroid drugs, but recurrence is common (50%) after short-term treatment.
• Risk factors for recurrence include younger age, higher FT4 levels, elevated TSH-binding inhibitory immunoglobulins, and goitre size.
• Long-term antithyroid drug therapy (5-10 years) significantly reduces recurrence rates (15%).
• Toxic nodular goitre is typically managed with radioiodine or thyroidectomy.
• Special populations (pregnant, COVID-19) and complications (atrial fibrillation, thyroid storm) require tailored approaches.

Conclusions:

• Effective hyperthyroidism management necessitates accurate diagnosis and tailored treatment.
• Long-term antithyroid drug therapy offers improved outcomes for Graves' disease.
• Further research into novel treatments targeting B cells or TSH receptors holds promise for Graves' disease.