Key messages

• Autonomous hypersecretion and deliberate overdose of thyroid hormones are the most common causes of severe hyperthyrodism.

• Thyrotoxicosis may be manifest by adverse changes in every organ system.

• Pyrexia and altered mental status are the hallmarks of thyrotoxic crisis, which is a rare but life-threatening complication of severe hyperthyroidism. Introduction

Hyperthyroidism is a clinical syndrome caused by exposure of the body tissues to excess circulating levels of free thyroxine and/or tri-iodothyronine. In over 90 per cent of patients hyperthyroidism is caused by one of the following:

1. Graves' disease;

2. toxic multinodular goiter;

3. toxic solitary nodule;

4. deliberate overdose of thyroid hormones.

Excess pituitary secretion of thyroid-stimulating hormone, intrinsic thyroid stimulating activity of human chorionic gonadotrophin in hydatidiform mole and choriocarcinoma, ovarian teratoma containing thyroid tissue, and metastatic differentiated carcinoma of the thyroid are unusual causes of hyperthyroidism.

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