Latest Evidence on Hyperthyroidism Symptoms, Treatment

TOPLINE:

Hyperthyroidism is most commonly caused by Graves disease. The global prevalence is 2% among women and 0.5% among men; if left untreated or undertreated, it can lead to cardiac arrhythmias, osteoporosis, heart failure, and adverse pregnancy outcomes.

A new review summarizes the most recent evidence regarding the pathophysiology, clinical presentation, and treatment of hyperthyroidism, clinical and subclinical Graves disease, and toxic nodular disease.

METHODOLOGY:

The review included data from 108 studies published between 2013 and 2023. The studies focused on hyperthyroidism and thyrotoxicosis.
The studies included four randomized clinical trials, 21 systematic reviews or meta-analyses, 40 longitudinal prospective or retrospective observational studies, two cross-sectional studies, and 41 reviews.
Current practice guidelines were also reviewed, along with additional references.

TAKEAWAY:

Among the most common symptoms of thyrotoxicosis are anxiety, insomnia, palpitations, unintentional weight loss, diarrhea, and heat intolerance. With Graves disease, additional symptoms may include a diffusely enlarged thyroid gland, stare, or exophthalmos on examination.
Toxic nodules, in which thyroid nodules develop autonomous function, may feature symptoms resulting from local compression of structures in the neck by the thyroid gland, including dysphagia, orthopnea, or voice changes.
Clinical presentation, thyroid function tests, and thyrotropin-receptor antibody status are key in establishing etiology. If thyroid nodules are present or the etiology is unclear, thyroid scintigraphy is recommended.
For most patients with symptoms of Graves disease, first-line treatment can begin with antithyroid drugs to reduce the synthesis and secretion of excess thyroid hormone. In addition, a β-blocker can be used initially to control tachycardia and palpitations for symptomatic patients and can be discontinued once thyroid hormone levels improve.
Radioactive iodine ablation (RAI) and surgery may be considered once hyperthyroidism is controlled. Evidence shows that RAI treatment cures hyperthyroidism for more than 90% of patients with Graves disease or autonomous thyroid nodules.
Treatment for subclinical hyperthyroidism is recommended for patients who are at highest risk of osteoporosis and cardiovascular disease, including those older than 65 years or with persistent serum thyrotropin level less than 0.1 mIU/L.

IN PRACTICE:

"This review is a good overview of hyperthyroidism for treating clinicians, including primary care providers and endocrinologists," said co-author Elizabeth N. Pearce, MD, a professor of medicine and an endocrinologist at Boston Medical Center, in Boston, Massachusetts, in a press statement.

"It includes information on pathophysiology, clinical presentation, diagnosis and treatment options for various etiologies of hyperthyroidism, as well as discussion of special cases such as subclinical hyperthyroidism, hyperthyroidism in pregnancy and thyroid storm," she said.

SOURCE:

The review was authored by Pearce and Sun Y. Lee, MD, also of the Boston University Chobanian and Avedisian School of Medicine. It was published in JAMA on October 17, 2023.

DISCLOSURES:

Pearce receives honoraria for speaking and travel support from the National Dairy Council, honoraria for speaking at the Merck China Symposium, and travel support for serving as the North American regional coordinator for the Iodine Global Network. She serves as a member of the American Thyroid Association's (ATA's) task force for the revision of thyroid in pregnancy guidelines.

Lee serves as a member of the ATA's task force for the revision of thyroid in pregnancy guidelines and received grants from the National Institute of Environmental Health Science during the conduct of the study.

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