Overview
Clinical Meaning
The NP manages hyperthyroidism through systematic diagnosis, treatment selection based on etiology and patient factors, and long term monitoring.
AGPCNP
AGPCNP
The NP manages hyperthyroidism through systematic diagnosis, treatment selection based on etiology and patient factors, and long-term monitoring. Diagnostic algorithm: suppressed TSH → confirm with free T4 and free T3 (T3 thyrotoxicosis if T3 alone is elevated). Determine etiology: TSI positive = Graves disease; RAIU high diffuse = Graves; focal = toxic adenoma or TMNG; low = thyroiditis, exogenous hormone, or struma ovarii. Treatment selection: (1) Graves disease in young patients or mild disease → ATD trial (methimazole 10-30 mg daily, titrate based on FT4; remission rate ~30-50% after 12-18 months); (2) Definitive therapy if ATD fails, large goiter, or patient preference → RAI or thyroidectomy; (3) Toxic nodular disease → RAI (ATDs do not achieve remission in nodular disease); (4) Subclinical hyperthyroidism (low TSH, normal FT4/FT3) → treat if persistent and TSH <0.1 with age >65 or cardiac disease (AF risk); observe if TSH 0.1-0.4. Graves ophthalmopathy: mild → artificial tears, smoking cessation (smoking worsens ophthalmopathy); moderate-severe → high-dose glucocorticoids, orbital radiotherapy, teprotumumab (anti-IGF-1R antibody). RAI is relatively contraindicated in moderate-severe Graves ophthalmopathy (may worsen it); if RAI is...
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