Evaluation of Hyperthyroidism and Hyperthyroid Goiter

  • Mirjam Christ-Crain
  • Nils G. Morgenthaler
  • Beat Mueller


The primary intention of this chapter is to focus on the diagnosis and treatment of the two most prevalent hyperthyroid states, i.e., Graves’ disease and solitary and multinodular goiter. In addition, we aim to provide some concise information on thyroid physiology and thyroid function tests.


Thyroid Hormone Thyroid Gland Radioactive Iodine Multinodular Goiter Antithyroid Drug 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Wartofsky L (2001) The thyroid gland. In: Becker KL (ed) Principles and practice of endocrinology and metabolism. Lippincott Williams & Wilkins, Philadelphia, pp 308–471Google Scholar
  2. 2.
    Spencer CA, LoPresti JS, Patel A, Guttler RB, Eigen A, Shen D, Gray D, Nicoloff JT (1990) Applications of a new chemiluminometric thyrotropin assay to subnormal measurement. J Clin Endocrinol Metab 70:453–460PubMedCrossRefGoogle Scholar
  3. 3.
    Christ-Crain M, Meier C, Roth CB, Huber P, Staub JJ, Muller B (2002) Basal TSH levels compared with TRH-stimulated TSH levels to diagnose different degrees of TSH suppression: diagnostic and therapeutic impact of assay performance. Eur J Clin Invest 32:931–937PubMedCrossRefGoogle Scholar
  4. 4.
    Brent GA (2008) Clinical practice. Graves’ disease. N Engl J Med 358:2594–2605PubMedCrossRefGoogle Scholar
  5. 5.
    Utiger RD (1995) Cigarette smoking and the thyroid. N Engl J Med 333:1001–1002PubMedCrossRefGoogle Scholar
  6. 6.
    Winsa B, Adami HO, Bergstrom R, Gamstedt A, Dahlberg PA, Adamson U, Jansson R, Karlsson A (1991) Stressful life events and Graves’ disease. Lancet 338:1475–1479PubMedCrossRefGoogle Scholar
  7. 7.
    Cooper DS (2003) Hyperthyroidism. Lancet 362:459–468PubMedCrossRefGoogle Scholar
  8. 8.
    Weetman AP (2000) Graves’ disease. N Engl J Med 343:1236–1248PubMedCrossRefGoogle Scholar
  9. 9.
    Zulewski H, Siggelkow H, Walden C, Becker W, Hufner M (1999) Evaluation of procollagen III peptide as a marker of tissue hyperthyroidism in long-term treated women with TSH suppressive doses of thyroxine. Exp Clin Endocrinol Diabetes 107:190–194PubMedCrossRefGoogle Scholar
  10. 10.
    Bartley GB, Fatourechi V, Kadrmas EF, Jacobsen SJ, Ilstrup DM, Garrity JA, Gorman CA (1996) Chronology of Graves’ ophthalmopathy in an incidence cohort. Am J Ophthalmol 121:426–434PubMedGoogle Scholar
  11. 11.
    Bahn RS (2010) Graves’ ophthalmopathy. N Engl J Med 362:726–738PubMedCrossRefGoogle Scholar
  12. 12.
    Kendall-Taylor P, Perros P (1998) Clinical presentation of thyroid associated orbitopathy. Thyroid 8:427–428PubMedCrossRefGoogle Scholar
  13. 13.
    Bartalena L, Tanda ML (2009) Clinical practice. Graves’ ophthalmopathy. N Engl J Med 360:994–1001PubMedCrossRefGoogle Scholar
  14. 14.
    Mourits MP, Prummel MF, Wiersinga WM, Koornneef L (1997) Clinical activity score as a guide in the management of patients with Graves’ ophthalmopathy. Clin Endocrinol (Oxf) 47:9–14CrossRefGoogle Scholar
  15. 15.
    Bartalena L, Baldeschi L, Dickinson AJ, Eckstein A, Kendall-Taylor P, Marcocci C, Mourits MP, Perros P, Boboridis K, Boschi A, Curro N, Daumerie C, Kahaly GJ, Krassas G, Lane CM, Lazarus JH, Marino M, Nardi M, Neoh C, Orgiazzi J, Pearce S, Pinchera A, Pitz S, Salvi M, Sivelli P, Stahl M, von Arx G, Wiersinga WM (2008) Consensus statement of the European group on Graves’ orbitopathy (EUGOGO) on management of Graves’ orbitopathy. Thyroid 18:333–346PubMedCrossRefGoogle Scholar
  16. 16.
    Eckstein AK, Plicht M, Lax H, Neuhauser M, Mann K, Lederbogen S, Heckmann C, Esser J, Morgenthaler NG (2006) Thyrotropin receptor autoantibodies are independent risk factors for Graves’ ophthalmopathy and help to predict severity and outcome of the disease. J Clin Endocrinol Metab 91:3464–3470PubMedCrossRefGoogle Scholar
  17. 17.
    Morgenthaler NG (1999) New assay systems for thyrotropin receptor antibodies. Curr Opin Endocrinol Diabetes 6:251–260CrossRefGoogle Scholar
  18. 18.
    Schott M, Scherbaum WA, Morgenthaler NG (2005) TSH-receptor autoantibodies in Graves’ disease: recent developments in the diagnosis and therapy monitoring. Trends Endocrinol Metab 16:243–248PubMedCrossRefGoogle Scholar
  19. 19.
    Singer PA, Cooper DS, Levy EG, Ladenson PW, Braverman LE, Daniels G, Greenspan FS, McDougall IR, Nikolai TF (1995) Treatment guidelines for patients with hyperthyroidism and hypothyroidism. Standards of Care Committee, American Thyroid Association. JAMA 273:808–812PubMedCrossRefGoogle Scholar
  20. 20.
    Cooper DS (2005) Antithyroid drugs. N Engl J Med 352:905–917PubMedCrossRefGoogle Scholar
  21. 21.
    Patil-Sisodia K, Mestman JH (2010) Graves hyperthyroidism and pregnancy: a clinical update. Endocr Pract 16:118–129PubMedCrossRefGoogle Scholar
  22. 22.
    Maugendre D, Gatel A, Campion L, Massart C, Guilhem I, Lorcy Y, Lescouarch J, Herry JY, Allannic H (1999) Antithyroid drugs and Graves’ disease – prospective randomized assessment of long-term treatment. Clin Endocrinol (Oxf) 50:127–132CrossRefGoogle Scholar
  23. 23.
    Schott M, Morgenthaler NG, Fritzen R, Feldkamp J, Willenberg HS, Scherbaum WA, Seissler J (2004) Levels of autoantibodies against human TSH receptor predict relapse of hyperthyroidism in Graves’ disease. Horm Metab Res 36:92–96PubMedCrossRefGoogle Scholar
  24. 24.
    Saenger EL, Thoma GE, Tompkins EA (1968) Incidence of leukemia following treatment of hyperthyroidism. Preliminary report of the Cooperative Thyrotoxicosis Therapy Follow-Up Study. JAMA 205:855–862PubMedCrossRefGoogle Scholar
  25. 25.
    Farrar JJ, Toft AD (1991) Iodine-131 treatment of hyperthyroidism: current issues. Clin Endocrinol (Oxf) 35:207–212CrossRefGoogle Scholar
  26. 26.
    Franklyn JA (1994) The management of hyperthyroidism. N Engl J Med 330:1731–1738PubMedCrossRefGoogle Scholar
  27. 27.
    Walter MA, Christ-Crain M, Eckard B, Schindler C, Nitzsche EU, Muller-Brand J, Muller B (2004) Radioiodine therapy in hyperthyroidism: inverse correlation of pretherapeutic iodine uptake level and post-therapeutic outcome. Eur J Clin Invest 34:365–370PubMedCrossRefGoogle Scholar
  28. 28.
    Imseis RE, Vanmiddlesworth L, Massie JD, Bush AJ, Vanmiddlesworth NR (1998) Pretreatment with propylthiouracil but not methimazole reduces the therapeutic efficacy of iodine-131 in hyperthyroidism. J Clin Endocrinol Metab 83:685–687PubMedCrossRefGoogle Scholar
  29. 29.
    Walter MA, Christ-Crain M, Muller B, Muller-Brand J (2005) Paired comparison of radioiodine uptakes and thyroid hormone levels on/off simultaneous carbimazole medication. A prospective paired comparison. Nuklearmedizin 44(1):33–36PubMedGoogle Scholar
  30. 30.
    Walter MA, Briel M, Christ-Crain M, Bonnema SJ, Connell J, Cooper DS, Bucher HC, Muller-Brand J, Muller B (2007) Effects of antithyroid drugs on radioiodine treatment: systematic review and meta-analysis of randomised controlled trials. BMJ 334:514PubMedCrossRefGoogle Scholar
  31. 31.
    Bartalena L, Marcocci C, Bogazzi F, Manetti L, Tanda ML, Dell’Unto E, Bruno-Bossio G, Nardi M, Bartolomei MP, Lepri A, Rossi G, Martino E, Pinchera A (1998) Relation between therapy for hyperthyroidism and the course of Graves’ ophthalmopathy. N Engl J Med 338:73–78PubMedCrossRefGoogle Scholar
  32. 32.
    Mao XM, Li HQ, Li Q, Li DM, Xie XJ, Yin GP, Zhang P, Xu XH, Wu JD, Chen SW, Wang SK (2009) Prevention of relapse of Graves’ disease by treatment with an intrathyroid injection of dexamethasone. J Clin Endocrinol Metab 94:4984–4991PubMedCrossRefGoogle Scholar
  33. 33.
    Garrity JA, Fatourechi V, Bergstralh EJ, Bartley GB, Beatty CW, DeSanto LW, Gorman CA (1993) Results of transantral orbital decompression in 428 patients with severe Graves’ ophthalmopathy. Am J Ophthalmol 116:533–547PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Mirjam Christ-Crain
    • 1
  • Nils G. Morgenthaler
    • 2
  • Beat Mueller
    • 3
  1. 1.Department of Endocrinology and DiabetologyUniversity Hospital BaselBaselSwitzerland
  2. 2.Department of Experimental EndocrinologyCharité Universitätsmedizin BerlinBerlinGermany
  3. 3.Innere Medizin, Kantonsspital AarauAarauSwitzerland

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