Overview of the clinical manifestations of hyperthyroidism in adults
- Douglas S Ross, MD
Douglas S Ross, MD
- Section Editor — Thyroid Disease
- Professor of Medicine
- Harvard Medical School
The clinical manifestations of hyperthyroidism are largely independent of its cause (see "Disorders that cause hyperthyroidism"). However, the disorder that causes hyperthyroidism may have other effects. In particular, Graves' disease, the most common cause of hyperthyroidism, causes unique problems that are not related to the high serum thyroid hormone concentrations. These include Graves' ophthalmopathy and infiltrative dermopathy (localized or pretibial myxedema). Most patients with Graves' hyperthyroidism have a diffuse goiter, but so do patients with other, less common causes of hyperthyroidism such as painless thyroiditis and thyroid-stimulating hormone (TSH)-secreting pituitary tumors.
The major clinical manifestations of hyperthyroidism (thyrotoxicosis) will be briefly reviewed here. More detailed discussions of its effects on specific organ systems as well as the diagnostic approach to patients with hyperthyroidism are discussed separately. (See "Diagnosis of hyperthyroidism".)
The skin is warm (and may rarely be erythematous) in hyperthyroidism due to increased blood flow; it is also smooth because of a decrease in the keratin layer . Other changes include:
●Sweating, which increases due to increased calorigenesis; this is often associated with heat intolerance
●Onycholysis (loosening of the nails from the nail bed, Plummer's nails) and softening of the nails
- Heymann WR. Cutaneous manifestations of thyroid disease. J Am Acad Dermatol 1992; 26:885.
- KIRKEBY K, HANGAARD G, LINGJAERDE P. THE PIGMENTATION OF THYROTOXIC PATIENTS. Acta Med Scand 1963; 174:257.
- Collet E, Petit JM, Lacroix M, et al. [Chronic urticaria and autoimmune thyroid diseases]. Ann Dermatol Venereol 1995; 122:413.
- Bilezekian JP, Loeb JN. The influence of hyperthyroidism and hypothyroidism on alpha- and beta-adrenergic receptor systems and adrenergic responsiveness. Endocrinol Rev 1983; 4:378.
- Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system: from theory to practice. J Clin Endocrinol Metab 1994; 78:1026.
- Iglesias P, Acosta M, Sánchez R, et al. Ambulatory blood pressure monitoring in patients with hyperthyroidism before and after control of thyroid function. Clin Endocrinol (Oxf) 2005; 63:66.
- Forfar JC, Muir AL, Sawers SA, Toft AD. Abnormal left ventricular function in hyperthyroidism: evidence for a possible reversible cardiomyopathy. N Engl J Med 1982; 307:1165.
- Frost L, Vestergaard P, Mosekilde L. Hyperthyroidism and risk of atrial fibrillation or flutter: a population-based study. Arch Intern Med 2004; 164:1675.
- Sawin CT, Geller A, Wolf PA, et al. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med 1994; 331:1249.
- Nakazawa HK, Sakurai K, Hamada N, et al. Management of atrial fibrillation in the post-thyrotoxic state. Am J Med 1982; 72:903.
- Siu CW, Jim MH, Zhang X, et al. Comparison of atrial fibrillation recurrence rates after successful electrical cardioversion in patients with hyperthyroidism-induced versus non-hyperthyroidism-induced persistent atrial fibrillation. Am J Cardiol 2009; 103:540.
- Bar-Sela S, Ehrenfeld M, Eliakim M. Arterial embolism in thyrotoxicosis with atrial fibrillation. Arch Intern Med 1981; 141:1191.
- Fuster V, Ryden LE, Cannom DS, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol. 2006; 48:e149.
- O'Brien T, Katz K, Hodge D, et al. The effect of the treatment of hypothyroidism and hyperthyroidism on plasma lipids and apolipoproteins AI, AII and E. Clin Endocrinol (Oxf) 1997; 46:17.
- Reasner CA. Autoimmune thyroid disease and type 1 diabetes. Diabetes Reviews 1993; 1:343.
- Andersen OO, Friis T, Ottesen B. Glucose tolerance and insulin secretion in hyperthyroidism. Acta Endocrinol (Copenh) 1977; 84:576.
- Mishra SK, Gupta N, Goswami R. Plasma adrenocorticotropin (ACTH) values and cortisol response to 250 and 1 microg ACTH stimulation in patients with hyperthyroidism before and after carbimazole therapy: case-control comparative study. J Clin Endocrinol Metab 2007; 92:1693.
- Ayres J, Rees J, Clark TJ, Maisey MN. Thyrotoxicosis and dyspnoea. Clin Endocrinol (Oxf) 1982; 16:65.
- Kahaly G, Hellermann J, Mohr-Kahaly S, Treese N. Impaired cardiopulmonary exercise capacity in patients with hyperthyroidism. Chest 1996; 109:57.
- Mercé J, Ferrás S, Oltra C, et al. Cardiovascular abnormalities in hyperthyroidism: a prospective Doppler echocardiographic study. Am J Med 2005; 118:126.
- Ch'ng CL, Biswas M, Benton A, et al. Prospective screening for coeliac disease in patients with Graves' hyperthyroidism using anti-gliadin and tissue transglutaminase antibodies. Clin Endocrinol (Oxf) 2005; 62:303.
- Nordyke RA, Gilbert FI Jr, Harada AS. Graves' disease. Influence of age on clinical findings. Arch Intern Med 1988; 148:626.
- Davis PJ, Davis FB. Hyperthyroidism in patients over the age of 60 years. Clinical features in 85 patients. Medicine (Baltimore) 1974; 53:161.
- Rosenthal FD, Jones C, Lewis SI. Thyrotoxic vomiting. Br Med J 1976; 2:209.
- Dalla Costa M, Mangano FA, Betterle C. Thymic hyperplasia in patients with Graves' disease. J Endocrinol Invest 2014.
- Yacoub A, Gaitonde DY, Wood JC. Thymic hyperplasia and Graves disease: management of anterior mediastinal masses in patients with Graves disease. Endocr Pract 2009; 15:534.
- Huang W, Molitch ME. Enlarged thymus in a patient with dyspnea and weight loss. JAMA 2015; 313:2174.
- Wortsman J, McConnachie P, Baker JR Jr, Burman KD. Immunoglobulins that cause thymocyte proliferation from a patient with Graves' disease and an enlarged thymus. Am J Med 1988; 85:117.
- Nightingale S, Vitek PJ, Himsworth RL. The haematology of hyperthyroidism. Q J Med 1978; 47:35.
- Franchini M, Lippi G, Targher G. Hyperthyroidism and venous thrombosis: a casual or causal association? A systematic literature review. Clin Appl Thromb Hemost 2011; 17:387.
- Stuijver DJ, van Zaane B, Romualdi E, et al. The effect of hyperthyroidism on procoagulant, anticoagulant and fibrinolytic factors: a systematic review and meta-analysis. Thromb Haemost 2012; 108:1077.
- Evered DC, Hayter CJ, Surveyor I. Primary polydipsia in thyrotoxicosis. Metabolism 1972; 21:393.
- Ridgway EC, Maloof F, Longcope C. Androgen and oestrogen dynamics in hyperthyroidism. J Endocrinol 1982; 95:105.
- Koutras DA. Disturbances of menstruation in thyroid disease. Ann N Y Acad Sci 1997; 816:280.
- Hudson RW, Edwards AL. Testicular function in hyperthyroidism. J Androl 1992; 13:117.
- Abalovich M, Levalle O, Hermes R, et al. Hypothalamic-pituitary-testicular axis and seminal parameters in hyperthyroid males. Thyroid 1999; 9:857.
- Carani C, Isidori AM, Granata A, et al. Multicenter study on the prevalence of sexual symptoms in male hypo- and hyperthyroid patients. J Clin Endocrinol Metab 2005; 90:6472.
- Ross DS. Hyperthyroidism, thyroid hormone therapy, and bone. Thyroid 1994; 4:319.
- Fatourechi V, Ahmed DD, Schwartz KM. Thyroid acropachy: report of 40 patients treated at a single institution in a 26-year period. J Clin Endocrinol Metab 2002; 87:5435.
- Stern RA, Robinson B, Thorner AR, et al. A survey study of neuropsychiatric complaints in patients with Graves' disease. J Neuropsychiatry Clin Neurosci 1996; 8:181.
- Thomas FB, Mazzaferri EL, Skillman TG. Apathetic thyrotoxicosis: A distinctive clinical and laboratory entity. Ann Intern Med 1970; 72:679.
- Trivalle C, Doucet J, Chassagne P, et al. Differences in the signs and symptoms of hyperthyroidism in older and younger patients. J Am Geriatr Soc 1996; 44:50.
- Boelaert K, Torlinska B, Holder RL, Franklyn JA. Older subjects with hyperthyroidism present with a paucity of symptoms and signs: a large cross-sectional study. J Clin Endocrinol Metab 2010; 95:2715.