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Updated: 9/17/2021

Hypothyroidism vs Hyperthyroidism

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  • Presentation
      • Symptoms/Physical Exam
      • Hypothyroidism
      • Hyperthyroidism
      • Cold intolerance (↓ heat production)
      • Heat intolerance (↑ heat production)
      • Weight gain
      • ↓ appetite
      • Weight loss
      • ↑ appetite
      • Hypoactivity
      • lLethargy
      • Fatigue
      • Weakness
      • Hyperactivity
      • Constipation
      • Diarrhea
      • ↓ reflexes
      • ↑ reflexes
      • Bradycardia
      • Tachycardia, palpitations, arrhythmias
      • Dry, cool skin
      • Coarse, brittle hair
      • Warm, moist skin
      • Fine hair
      • Diastolic hypertension (Na/H2O retention)
      • Systolic hypertension
      • Myxedema (facial/periorbital)
      • Osteoporosis
    • Heat intolerance (↑ heat production)
    • Weight loss
    • ↑ appetite
    • Hyperactivity
    • Diarrhea
    • ↑ reflexes
    • Tachycardia, palpitations, arrhythmias
    • Warm, moist skin
    • Fine hair
  • Evaluation
      • Labs
      • Hypothyroidism
      • Hyperthyroidism
      • ↓ TSH (best first test)
      • ↓ total T4
      • ↑ total T4
      • ↓ free T4
      • ↑ free T4
      • Hyper cholesterolemia (↓ LDL receptor synthesis)
      • Hypo cholesterolemia (↑ LDL receptor synthesis)
      • Elevated serum creatine kinase
      • --
    • ↓ TSH (best first test)
    • ↑ total T4
    • ↑ free T4
  • Treatment
      • Treatment
      • Hypothyroidism
      • Hyperthyroidism
      • Levothyroxine
      • ThionamidesAblative131I therapy
      • Ablative 131I therapy
    • Thionamides
    • Ablative 131I therapy

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(M1.EC.15.75) A 34-year-old female presents to her primary care physician complaining of fatigue. Over the last three months she has experienced decreased energy and gained 7 pounds. Review of systems is negative for symptoms of depression but is positive for constipation, myalgias, and cold intolerance. Physical exam is notable for delayed deep tendon reflex relaxation. Vital signs are as follows: T 37.1 C, HR 61, BP 132/88, RR 16, and SpO2 100%. Which of the following is the best initial screening test for this patient?

QID: 106821

Level of anti-thyroid peroxidase (TPO) antibodies

5%

(6/120)

Morning cortisol and plasma ACTH

3%

(4/120)

Serum Free T4

18%

(22/120)

Serum TSH

68%

(81/120)

Hemoglobin and hematocrit

2%

(2/120)

M 2 D

Select Answer to see Preferred Response

(M1.EC.13.69) A 58-year-old Caucasian female presents to her primary care physician with concerns about several recent health changes. The patient has recently gained weight and can't seem to exercise like she used to. She also notes that her thinking seems slow. Physical examination shows thickened, dry skin. Serum analysis confirms the physician's suspicions. Which of the following findings was most helpful in the diagnosis?

QID: 100370

High T4 and T3

5%

(5/95)

Low T4 and T3

29%

(28/95)

High TSH

42%

(40/95)

Hypercholesterolemia

2%

(2/95)

Low TSH

15%

(14/95)

M 2 E

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(M1.EC.13.81) A 25-year-old female presents with recent muscle weakness, fatigue, and constipation. Physical examination reveals a bradycardic patient with cool, dry skin. Which of the following lab values would be most likely to be present with this patient's presentation?

QID: 100382

Elevated serum calcitonin

2%

(4/181)

Elevated serum CK

24%

(43/181)

Low serum TSH

36%

(65/181)

Activating TSH-receptor immunoglobulins

17%

(31/181)

Hypocalcemia

18%

(32/181)

M 2 E

Select Answer to see Preferred Response

Evidence (8)
VIDEOS & PODCASTS (1)
EXPERT COMMENTS (35)
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