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Hyperthyroidism and thyrotoxicosis C013

Document
Last amended 
2 April 2020
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
Brief description

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.  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.

Confirming the diagnosis

The diagnosis is made from blood tests showing levels of thyroid hormones (TSH, T3 and T4).  An additional finding of thyroid stimulating autoantibody usually indicates Graves’ disease, which is covered by a separate SOP.  Additional testing, such as ultrasound scanning or radionuclide imaging may be undertaken to further identify the pathology.

The appropriate specialist is an endocrinologist.

Additional diagnoses covered by SOP
  • Nil
Conditions excluded from SOP
  • Hashimoto’s thyroiditis*
  • Graves’ disease*
  • Subclinical hyperthyroidism (N.I.F.)
  • Sick Euthyroid syndrome#
  • Gestational transient thyrotoxicosis#
  • Euthyroid hyperthyroxinaemia#
  • Toxic multinodular goitre* - goitre SOP
  • Toxic uninodular goitre* - goitre SOP
  • Toxic thyroid adenoma* goitre SOP

* Another SOP applies

# Non-SOP condition

Clinical onset

The clinical presentation and the extent of symptoms is variable.  Classic symptoms are non-specific and include heat intolerance, tremor, palpitations, anxiety, weight loss despite a normal or increased appetite, increased frequency of bowel movements, and shortness of breath.

Clinical worsening

The condition is usually responsive to appropriate treatment and able to be well controlled.  Various treatment approaches may be used depending on the underlying cause. Worsening that is ongoing is unlikely.