Causes of thyrotoxicosis Causes of Hypothyroidism

A.Primary hyperthyroidism A.Primary Hypothyroidism

1) Graves' disease 1) Autoimmune hypothyroidism:
2) Toxic multinodular goiter  Hashimoto's thyroiditis
3) Toxic adenoma  Atrophic thyroiditis
4) Functioning thyroid carcinoma metastases 2) Drugs:
5) Activating mutation of the TSH receptor  iodine excess (including iodine-containing contrast
6) Activating mutation of Gsα (McCune-Albright media)
syndrome)  Amiodarone
7) Struma ovarii  Lithium
8) Drugs: iodine excess (Jod-Basedow phenomenon)
B. Secondary hyperthyroidism
 Anti-thyroid drugs

1) TSH-secreting pituitary adenoma  p-aminosalicyclic acid

 interferon-α
2) Thyroid hormone resistance syndrome: occasional
 other cytokines, aminoglutethimide
patients may have features of thyrotoxicosis
3) HCG-secreting tumors 3) Iatrogenic:
4) Gestational thyrotoxicosis  131
I treatment
C. Thyrotoxicosis without hyperthyroidism  Subtotal or total thyroidectomy
1) Sub acute thyroiditis  External irradiation of neck for lymphoma or
2) Silent thyroiditis cancer
3) Other causes of thyroid destruction: amiodarone, 4) Congenital hypothyroidism
radiation, infarction of adenoma  absent or ectopic thyroid gland
4) Ingestion of excess thyroid hormone (thyrotoxicosis
 dyshormonogenesis
factitia)
 TSH-R mutation
Nb. Circulating TSH levels are low in these forms of 5) Infiltrative disorders
secondary hyperthyroidism.  Amyloidosis
 Sarcoidosis
 Hemochromatosis
 Scleroderma
 Cystinosis
 Riedel's thyroiditi
6) Iodine deficiency
7) Overexpression of type 3 deoiodinase in infantile
hemangioma
8) Transient
9) Silent thyroiditis, including postpartum thyroiditis
10) Subacute thyroiditis
11) Withdrawal of thyroxine treatment in individuals
with an intact thyroid
B.Secondary Hypothyroidism
1) Hypopituitarism: tumors, pituitary surgery or
irradiation, infiltrative disorders, Sheehan's
syndrome, trauma, genetic forms of combined
pituitary hormone deficiencies
2) Isolated TSH deficiency or inactivity
3) Bexarotene treatment
4) Hypothalamic disease: tumors, trauma, infiltrative
disorders, idiopathic