Lancet. 2024 Feb 24;403(10428):768-780. doi: 10.1016/S0140-6736(23)02016-0. Epub 2024 Jan 23.


Thyrotoxicosis causes a variety of symptoms and adverse health outcomes. Hyperthyroidism refers to increased thyroid hormone synthesis and secretion, most commonly from Graves' disease or toxic nodular goitre, whereas thyroiditis (typically autoimmune, viral, or drug induced) causes thyrotoxicosis without hyperthyroidism. The diagnosis is based on suppressed serum concentrations of thyroid-stimulating hormone (TSH), accompanied by free thyroxine and total or free tri-iodothyronine concentrations, which are raised (overt hyperthyroidism) or within range (subclinical hyperthyroidism). The underlying cause is determined by clinical assessment, detection of TSH-receptor antibodies and, if necessary, radionuclide thyroid scintigraphy. Treatment options for hyperthyroidism include antithyroid drugs, radioactive iodine, and thyroidectomy, whereas thyroiditis is managed symptomatically or with glucocorticoid therapy. In Graves' disease, first-line treatment is a 12-18-month course of antithyroid drugs, whereas for goitre, radioactive iodine or surgery are preferred for toxic nodules or goitres. Evidence also supports long-term treatment with antithyroid drugs as an option for patients with Graves' disease and toxic nodular goitre.

Publication types

  • Review

MeSH terms

  • Antithyroid Agents / adverse effects
  • Antithyroid Agents / therapeutic use
  • Goiter, Nodular* / chemically induced
  • Goiter, Nodular* / diagnosis
  • Goiter, Nodular* / therapy
  • Graves Disease* / diagnosis
  • Graves Disease* / therapy
  • Humans
  • Hyperthyroidism* / drug therapy
  • Hyperthyroidism* / therapy
  • Iodine Radioisotopes / therapeutic use
  • Thyroid Neoplasms* / drug therapy
  • Thyroiditis* / chemically induced
  • Thyroiditis* / drug therapy
  • Thyrotoxicosis* / chemically induced
  • Thyrotoxicosis* / diagnosis
  • Thyrotoxicosis* / therapy


  • Antithyroid Agents
  • Iodine Radioisotopes