Thyrotoxicosis and thyroiditis

Thyrotoxicosis is a common presentation of thyroid disease. The commonest cause is Graves’ disease. The clinical features including goitre, eye disease, causes and diagnosis of thyrotoxicosis are discussed. Treatment strategies of Graves’ disease include anti-thyroid drugs, radioiodine and thyroidectomy. It is important to adequately prepare patients prior to surgery to reduce the possibility of thyroid storm. The preferred surgical procedure today is a total thyroidectomy, although historically subtotal thyroidectomy was performed. Less common but relevant surgical causes of thyrotoxicosis are also discussed.Thyroiditis (thyroid inflammation) has a variety of causes. Hashimoto's thyroiditis may present with a transient thyrotoxicosis or long term hypothyroidism. Surgery is rarely required. Subacute thyroiditis thought to be secondary to a viral infection can cause a short-term yet marked thyrotoxicosis due to thyroid damage. Other causes such as amiodarone-induced thyrotoxicosis can be more difficult to manage due to the underlying heart disease and may require thyroidectomy.