When a patient presents with evidence of high thyroid output such as thyrotoxicosis, what types of illness should be considered?
One should look for exogenous administration of thyroid hormone. We look for autoimmune diseases such as Graves’ disease, toxic multiple nodule goiter, atoxic adenoma otherwise known as Plummer’s disease which is where a person has a solitary nodule of the thyroid which is putting out a lot of thyroid hormone. There is such a thing call Hashitoxicosis. We also look for the de-Quervain sub acute thyroiditis. These patients usually have an elevated thyroid T4 in the blood stream, elevated thyroid binding globulin that is usually very high with increased sedimentation rate. We also see problems with silent thyroiditis, thyrotropinona of the pituitary. We see problems with thyrophoblastic thyroid hormone resistance and struma ovarii, which is a special case where we find that ovarian tissue has the ability to make thyroid hormone, which then can give problems with thyrotoxicosis. When one sees a patient with hypothyroidism we start considering things such as chronic lymphocytic thyroiditis
