What follow-up tests should be considered for a patient with newly diagnosed hyperthyroidism to assess the underlying cause?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 22 August 2025Updated: 22 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

For a patient with newly diagnosed hyperthyroidism, follow-up tests to assess the underlying cause depend on whether the patient is an adult or a child/young person . The aim is to differentiate between thyrotoxicosis with hyperthyroidism (such as Graves' disease or toxic nodular disease) and thyrotoxicosis without hyperthyroidism (such as transient thyroiditis) .

  • For adults:
    • TSH receptor antibodies (TRAbs) should be measured to confirm Graves' disease .
    • If TRAbs are negative, technetium scanning of the thyroid gland should be considered .
    • Ultrasound should only be considered if the adult has a palpable thyroid nodule .
  • For children and young people:
    • TPOAbs and TRAbs should be measured .
    • If TRAbs are negative, technetium scanning of the thyroid gland should be considered .
    • Ultrasound should only be offered if there is a palpable thyroid nodule or if the cause of thyrotoxicosis remains unclear after thyroid autoantibody testing and technetium scanning .

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