Disorders that cause hyperthyroidism

Disorders that cause hyperthyroidism

Author
Douglas S Ross, MD
Section Editor
David S Cooper, MD
Deputy Editor
Jean E Mulder, MD
Disclosures
All topics are updated as new evidence becomes available and our peer review process is
complete.
Literature review current through: Oct 2012. | This topic last updated: May 22, 2012.
INTRODUCTION Several different disorders can cause hyperthyroidism. It is essential that
the correct cause be identified because appropriate therapy depends upon the underlying
mechanism of the hyperthyroidism. From a pathogenetic viewpoint, hyperthyroidism results
from two different mechanisms that can be distinguished by the findings on the 24-hour
radioiodine uptake (table 1):

Hyperthyroidism with a normal or high radioiodine uptake indicates de novo synthesis of

hormone. These disorders can be treated with a thionamide, such as methimazole, which
will interfere with hormone synthesis. (See "Thionamides in the treatment of Graves'
disease".)

Hyperthyroidism with a near absent radioiodine uptake indicates either inflammation and
destruction of thyroid tissue with release of preformed hormone into the circulation or an
extrathyroidal source of thyroid hormone. Thyroid hormone is not being actively
synthesized when hyperthyroidism is due to thyroid inflammation; as a result, thionamide
therapy is not useful in these disorders.

This topic will review the main causes of hyperthyroidism and outline the therapeutic approach
to the less common conditions. The treatment of Graves' disease and toxic nodular goiter and the
diagnostic approach to patients with hyperthyroidism are discussed separately. (See "Diagnosis
of hyperthyroidism".)
EPIDEMIOLOGY Hyperthyroidism is more common in women than men (5:1 ratio). The
overall prevalence of hyperthyroidism, which is approximately 1.3 percent, increases to 4 to 5
percent in older women [1]. Hyperthyroidism is also more common in smokers [2]. Graves'
disease is seen most often in younger women, while toxic nodular goiter is more common in
older women.
In one prospective cohort study of adult women, the overall incidence of Graves' disease was 4.6
per 1000 during 10 years of observation [3].

HYPERTHYROIDISM WITH A NORMAL OR HIGH RADIOIODINE

UPTAKE Autoimmune thyroid disease and autonomous thyroid tissue are the major causes of
excess new hormone synthesis by the thyroid.
Graves' disease Graves' disease is the most common cause of hyperthyroidism [4]. It is an
autoimmune disorder resulting from thyrotropin (TSH)-receptor antibodies (also called thyroidstimulating immunoglobulins), which stimulate thyroid gland growth and thyroid hormone
synthesis and release [5]. Stressful life events may be a risk factor for the disease [6]. Another
risk factor may be a relatively high iodine intake [7]. Ophthalmopathy and pretibial myxedema
are additional autoimmune manifestations of Graves' disease. (See "Pathogenesis of Graves'
disease".)