Hyperthyroidism
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Population Covered By The Guidance
This pathway provides guidance on the investigation of adult patients with hyperthyroidism.
Date reviewed: February 2018
Date of next review: June 2023
Published: June 2018
Quick User Guide
Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
Clicking on the PINK text box will bring up the full text.
The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
| SYMBOL | RRL | EFFECTIVE DOSE RANGE |
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None | 0 |
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Minimal | < 1 millisieverts |
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Low | 1-5 mSv |
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Medium | 5-10 mSv |
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High | >10 mSv |
Images
Image GalleryNote: These images open in a new page |
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| 1a |  |
Graves' Disease Image 1a and 1b (Thyroid Scintigraphy - Tc99m Pertechnetate): The thyroid gland has taken up 6.3% of the administered dose (normal between 0.6-2.7%). This is evenly distributed throughout both lobes of the thyroid gland. No focal abnormalities are demonstrated. The appearances are typical of Graves' Disease. |
| 1b |  |
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| 2 |  |
Image 2 (H&E, x10): Histological section of Graves' disease showing hyperplastic follicles with infolding of the follicular epithelium to form papillary projections (blue arrow). The colloid is pale with scalloped margins (green arrows). |
| 3a |  |
Retrosternal Goitre Image 3a, 3b, 3c and 3d (Computed Tomography): The right lobe of the thyroid is considerably enlarged with retrosternal extension and deviation of the trachea to the left (arrows). There are a few mediastinal nodes which measure around 1cm in short axis diameter. |
| 3b |  |
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| 3c |  |
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| 3d |  |
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| 4a |  |
Multinodular (Colloid) Goitre
Image 4a: Total thyroidectomy showing a multinodular goitre with marked asymmetrical enlargement of the right lobe due to a massive dominant nodule. |
| 4b |  |
Image 4b (H&E, x2.5): Histological section of a multinodular (colloid) goitre showing the usual features of variously sized, colloid-containing follicles lined by uniform epithelial cells, patchy areas of haemorrhage and fibrosis. |
Teaching Points
Teaching Points
- Graves' disease can often be diagnosed clinically and appropriate medication commenced
- If the aetiology of hyperthyroidism is uncertain, isotope scan may aid in the diagnosis based on the pattern and location of radionuclide uptake
References
References
Date of literature search: September 2017
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- De Leo S, Lee SY, Braverman LE. Hyperthyroidism. Lancet. 2016;388(10047):906-18. (Review article). View the reference
- Lacka K, Fraczek MM. Classification and etiology of hyperthyroidism. Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 2014;36(213):206-11. (review article). View the reference
- Meller J, Becker W. The continuing importance of thyroid scintigraphy in the era of high-resolution ultrasound. Eur J Nucl Med Mol Imaging. 2002;29 Suppl 2:S425-38. (Review article). View the reference
- Summaria V, Salvatori M, Rufini V, Mirk P, Garganese MC, Romani M. Diagnostic imaging in thyrotoxicosis. Rays. 1999;24(2):273-300. (Review article). View the reference
- Alimanovic-Alagic R, Brkovic A, Kucukalic-Selimovic E, Skopljak-Beganovic A. Thyroid scintigraphy as diagnostic method evaluation of thyroid diseases. Med Arh. 2008;62(2):114-6. (Review article). View the reference
- Smith JR, Oates E. Radionuclide imaging of the thyroid gland: patterns, pearls, and pitfalls. Clin Nucl Med. 2004;29(3):181-93. (Review article). View the reference
- Intenzo CM, dePapp AE, Jabbour S, Miller JL, Kim SM, Capuzzi DM. Scintigraphic manifestations of thyrotoxicosis. Radiographics. 2003;23(4):857-69. (Review article). View the reference
- Kusic Z, Becker DV, Saenger EL, Paras P, Gartside P, Wessler T, et al. Comparison of technetium-99m and iodine-123 imaging of thyroid nodules: correlation with pathologic findings. J Nucl Med. 1990;31(4):393-9. (Level III evidence). View the reference
- Gupta V. Physiopathologic atlas of thyroid scintigraphy. Kathmandu University medical journal (KUMJ). 2007;5(4):583-90. (Review article). View the reference
- Meng Z, Zhang G, Sun H, Tan J, Yu C, Tian W, et al. Differentiation between Graves' disease and painless thyroiditis by diffusion-weighted imaging, thyroid iodine uptake, thyroid scintigraphy and serum parameters. Experimental and Therapeutic Medicine. 2015;9(6):2165-72. (Level III evidence). View the reference
Information for Consumers
Information for Consumers
Information from this website |
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Consent to Procedure or Treatment Radiation Risks of X-rays and Scans |
Radiation Risk of Medical Imaging During Pregnancy Radiation Risk of Medical Imaging for Adults and Children |
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