Hyperthyroidism (Overactive Thyroid): Classification

Hyperthyroidism is classified according to symptoms into:

  • Subclinical (latent) hyperthyroidism – asymptomatic (with no apparent symptoms).
  • Clinical hyperthyroidism – hyperthyroidism associated with symptoms.

Hyperthyroidism is classified according to the location of the disorder into:

  • Primary hyperthyroidism – “true” hyperthyroidism.
    • Manifest form – elevation of free triiodothyronine (fT3) and/or free thyrosine (fT4) above the upper normal range and concomitant TSH decrease (= suppressed basal thyroid-stimulating hormone (TSH)).
    • Subclinical (latent) form – isolated TSH depression.
  • Secondary hyperthyroidism – this is an excessive stimulation by increased TSH activity (eg, in hormone-forming tumors of the pituitary gland (pituitary gland)).

Akamizu criteria for assessing the likelihood of thyrotoxic crisis.

Main criterion 1 Main criterion 2 Secondary criterion 1 Secondary criterion 2
Elevated fT4 or fT3 levels.
  • CNS manifestations (agitation, delirium, psychosis, seizure, impaired consciousness).
  • Body temperature ≥ 38°C
  • Heart rate ≥ 130/min
  • Cardiac decompensation,
  • Gastrointestinal and hepatic manifestations.
  • History of thyroid disease,
  • Goiter
  • Exophthalmos
Definite thyrotoxic crisis Both major criteria and one of the minor criteria 1 or major criterion 1 and at least 3 of the minor criteria 1
Suspicion of thyrotoxic crisis Major criterion 1 and exactly 2 of minor criteria 1 or major criterion 2 and one of minor criteria 1 and all of minor criteria 2 or so super accurate in my sense at least 3 of minor criteria 1 and all of minor criteria 2

Forms of amiodarone-induced thyrotoxicosis (AMT).

Type I Type II
Pathogenesis (disease development) Iodine induced in existing thyroid disease (Graves’ disease or autonomy. Destructive thyroiditis (inflammation of the thyroid gland).
ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), interleukin-6. mostly normal mostly elevated
Color duplex ultrasonography (ultrasound procedure that simultaneously assesses vessel walls and visualizes blood flow in a vessel) Perfusion increased Perfusion decreased
TcTU (technetium uptake) in scintigraphy. Unchanged or increased reduced
Therapy Thyrostatic agents, lithium if necessary NSAIDs (nonsteroidal anti-inflammatory drugs) or steroids