Differential
Graves disease (positive TSI and TBII, increased thyroid vascularity on US)
Thyroid Storm (severe hyperthyroidism presenting with multi-organ involvement: AMS, high fever, heart failure, diarrhea, and jaundice)
Nodular Thyroid disease (normal TSI/TBII)
Thyroiditis (Painful goiter)
Labs
Thyroid Stimulating Immunoglobulins (TSI)
Thyrotropin Binding Inhibitory Immunoglobulin (AKA TSH Receptor Binding Antibody)
Imaging
US soft tissue neck thyroid. Looking for increased vascularity (hyperemia) of the thyroid gland and for nodules
Radioactive Iodine uptake to look for hot nodules
Management
Rx: Atenolol, Propranolol
Rx Methimazole or PTU (for 1st trimester and for thyroid storm)
Avoid iodine contrast or iodine containing medications
Recheck TSH and Free T4 monthly while titrating methimazole dose
Adrenal Adenomas
Pituitary Adenomas
DKA