Hyper3

• Investigations for thyroid disorders

  1. TSH suppressed

  2. Serum free T4 level high

  3. Serum free T3 and T4 level high

  4. Serum TSH level suppressed (only pituitary adenomas will have high TSH, all others will have inhibited TSH release)

  5. TSH receptor antibodies for graves' disease

  6. Thyroid ultrasound or radionucleotide scan to differentiate between graves' disease, toxic adenoma, or multinodular goiter
• Graves' disease

  • Gland is diffusely enlarged with homogenous uptake
• Toxic adenoma

  • Solitary nodule with increased uptake in a background of suppressed uptake in the rest of the gland
• Toxic multinodular goiter


  • Diffusely multinodular gland with heterogeneous uptake
• Associated with thyroid disorders

  • Hypokalemia
  • Hypercalcemia
  • Hypoalbuminemia
• Thyroid antibodies

  • Thyroglobulin (detects recurrence of thyroid cancer)
  • Thyroid-stimulating immunoglobulin (TSI) (confirms graves, not positive in toxic multinodular goiter)
  • Thyroperoxidase antibody (TPO) (may be seen in grave's disease but more characteristically in Hashimoto thyroiditis)