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Hyperthyroidism and thyrotoxicosis C013

Document
Last amended 
26 June 2015
Current RMA Instruments:
Reasonable Hypothesis SOP
27 of 2013
Balance of Probabilities SOP
28 of 2013
Changes from Previous Instruments:

SOP Bulletin 165

ICD Coding:
  • ICD-9-CM Codes: 242.4-242.9
  • ICD-10-AM Codes: E05.9, E05.3, E05.8

This is a pathology where there is an elevated level of thyroid hormone in the blood with symptoms or signs of thyroid hyperfunction.  If the elevation in thyroid hormone is due to excessive thyroid gland secretion, then it is called hyperthyroidism and if it is not due to thyroid gland excessive secretion then it is called thyrotoxicosis.  Several of the most common causes of hyperthyroidism are not covered by this SOP (see comments below).

Is specific diagnostic evidence required to apply the SOP? – No.

The diagnosis is made by blood test showing elevated levels of thyroxine.  An additional finding of thyroid stimulating autoantibody usually indicates Graves’ disease, which is covered by a separate SOP.  The appropriate specialist is an endocrinologist.

Are there sub-factors that require specific information? – Yes.

There are factors that are specific to thyrotoxicosis only.

Additional diagnoses covered by SOP
  • Nil
Conditions excluded from SOP
  • Hashimoto’s thyroiditis, ICD code 245.2
  • Graves’ disease, ICD code 242.0
  • Subclinical hyperthyroidism (N.I.F.)
  • Sick Euthyroid syndrome, ICD code 790.94
  • Gestational transient thyrotoxicosis
  • Euthyroid hyperthyroxinaemia
  • Toxic multinodular goitre, ICD code 242.2
  • Toxic uninodular goitre, ICD code 242.1
  • Toxic thyroid adenoma, ICD code 242.1
Unconfirmed diagnosis

If, after considering the above information you are unable to apply the SOP, you should then:

  1. seek medical officer advice about further investigation, or;
  2. generate a diagnostic report, or;
  3. re-encode the condition, if appropriate.

The following investigations may be useful in establishing the diagnosis.

  • report from treating specialist
  • results of thyroid hormone testing
Comments

Graves’ disease, toxic thyroid adenoma and toxic multimodular goitre account for the large majority of cases of hyperthyroidism but are covered by other SOPs and not this SOP.  Graves’ disease has its own SOP.  Toxic adenoma and toxic goitre are covered by the goitre SOP.