Hyperthyroidism vs Hypothyroidism
Hyperthyroidism and Hypothyroidism are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Hyperthyroidism vs Hypothyroidism at a glance
- Hyperthyroidism: Autoimmune diffuse goiter driven by TSH-receptor stimulating antibodies; most common cause of overt hyperthyroidism.
- Hypothyroidism: Autoimmune chronic lymphocytic thyroiditis; most common cause of hypothyroidism in iodine-replete regions.
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Side-by-side comparison
| Feature | Hyperthyroidism | Hypothyroidism |
|---|---|---|
| At a glance | Autoimmune diffuse goiter driven by TSH-receptor stimulating antibodies; most common cause of overt hyperthyroidism. | Autoimmune chronic lymphocytic thyroiditis; most common cause of hypothyroidism in iodine-replete regions. |
| Classic presentation | Young woman with weight loss, palpitations, anxiety, diffuse goiter with bruit, and proptosis = Graves disease.; Heat intolerance, sweating, palpitations,… | Middle-aged woman with fatigue, weight gain, cold intolerance, diffuse firm bumpy goiter, and delayed reflex relaxation.; Fatigue, cold intolerance, weight… |
| Workup / key labs | Suppressed TSH + elevated free T4 and/or T3 + positive TRAb, or diffuse uptake on RAIU scan. Orbitopathy or pretibial myxedema with biochemical thyrotoxicosis… | Elevated TSH with low free T4 (overt) or normal free T4 (subclinical), supported by positive anti-TPO antibodies.; TSH — elevated (most sensitive screening… |
| Imaging | Radioactive iodine uptake and scan (RAIU/scan) — diffuse, homogeneous, ELEVATED uptake confirms Graves; differentiates from low-uptake thyroiditis and… | Ultrasound only if nodule, asymmetry, or compressive symptoms — heterogeneous hypoechoic pattern with pseudonodules typical of Hashimoto; RAIU not routinely… |
| First-line treatment | Beta-blocker for adrenergic symptoms — propranolol 20-40 mg q6h (also blocks peripheral T4→T3 conversion at high dose) or atenolol/metoprolol; use cautiously… | Levothyroxine (synthetic T4) — start 1.6 mcg/kg/day in healthy young adults; start lower (25-50 mcg) in elderly or known CAD; take on empty stomach 30-60 min… |
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