Hyperthyroidism for the Primary Care NP

• Confirm pt was not taking biotin at the time of the lab draw because it can cause lab error that looks like hyperthyroidism 
• Labs
  • TSH: low 
  • T4: may be increase with or without increase in T3
  • T3: may be increase with or without increase in T4 
• Assess for urgent symptoms that could indicate thyroid storm
  • use Burch-Wartofsky Point Scale (you can find on up-to-date here)
  • looks at temperature, CNS symptoms, GI symptoms, HR, HF symptoms to give the likelihood of thyroid storm 
• if no urgent symptoms, refer to endocrinology 
• concerning symptoms: fever, delirium, abdominal pain, N/V/D, tachycardia 
• most common cause is Grave's disease 

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