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

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 ¹. 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) ¹.

• For adults:
  • TSH receptor antibodies (TRAbs) should be measured to confirm Graves' disease ¹.
  • If TRAbs are negative, technetium scanning of the thyroid gland should be considered ¹.
  • Ultrasound should only be considered if the adult has a palpable thyroid nodule ¹.
• For children and young people:
  • TPOAbs and TRAbs should be measured ¹.
  • If TRAbs are negative, technetium scanning of the thyroid gland should be considered ¹.
  • 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 ¹.