[Hyperthyroidism].

Abstract

Although the classical presentation of hyperthyroidism is known from the nineteenth century, the mindful evaluation of the clinical symptoms is indispensable for the practitioner physician. The clinical picture depends on the etiology of hyperthyroidism, the gender and age of the patient. The methods for the laboratory diagnosis of hyperthyroidism have outstanding accuracy, the supersensitive TSH, free thyroxine and triiodothyronine determinations are generally available. The etiology of hyperthyroidism was broadened by new diseases: gestational hyperthyroidism caused by human choriogonadotropin and the group of congenital non-autoimmune hyperthyroidism due to TSH receptor mutations were discovered. The iodine-induced hyperthyroidism, which is an everyday problem due to the widespread use of amiodarone treatment, is also better characterized. The role of different treatment modalities in the therapeutic algorithm was established, the part of surgery decreased. The optimal duration and dose of drug treatment in Graves' disease is still questionable in the lack of good evidence, nowadays one and half year of antithyroid treatment is generally recommended. The reduction of relapse rate below 50% after the discontinuation of antithyroid drug was unsuccessful, risk factors are the large goiter, elevated level of the TSH receptor antibodies, in certain studies the male gender and young age. Due to the high relapse rate, the radioiodine treatment is preferred, even as a primary therapy. In case of toxic adenoma, toxic multinodular goiter and congenital non-autoimmune hyperthyroidism the medical treatment cannot result in permanent cure, therefore primary ablative treatment is required. The chances of patients with hyperthyroidism for the complete recovery are excellent, however, long time follow-up is necessary.