Hyperthyroidism

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...