Table 2.
Diagnosis of SHyper
| Level I | Level II | Level III |
| To establish the diagnosis of persistent | To establish the aetiology of SHyper | To establish the risks associated with SHyper and appropriate treatment |
| SHyper | ||
| TSH (initial screening) | Thyroid ultrasonography1 | CT, MRI3 |
| FT4, TT3 or FT3 (if serum TSH is low) | Thyroid scan and possibly thyroid radioiodine uptake | ECG4, Holter ECG5, Doppler echocardiography6 |
| TSHR-Abs2 | BMD7 | |
1
Ultrasonography can guide fine needle aspiration biopsy in cases of suspicious hypofunctioning thyroid nodules in nodular goitres.
2
TSH-receptor antibodies (TSHR-Abs) can be useful to identify autoimmune SHyper.
3
Computed tomography (CT) or magnetic resonance imaging (MRI) should be use din selected patients to assess airway compression.
4
ECG should be considered in symptomatic patients.
5
Holter ECG is useful to assess atrial arrhythmias.
6
Doppler echocardiography is recommended in patients with AF, CHD or HF and/or underlying heart disease.
7
BMD should be evaluated in postmenopausal patients, in elderly patients and in patients with underlying bone risk factors.