ETIOLOGY

Causes of thyroid hormone excess include primary hyperthyroidism (Graves’ disease, toxic multinodular goiter [MNG], toxic adenoma, iodine excess); thyroid destruction (subacute thyroiditis, silent thyroiditis, amiodarone, radiation); extrathyroidal sources of thyroid hormone (thyrotoxicosis factitia, struma ovarii, functioning follicular carcinoma); and secondary hyperthyroidism (TSH-secreting pituitary adenoma, thyroid hormone resistance syndrome, human chorionic gonadotropin [hCG]-secreting tumors, gestational thyrotoxicosis). Graves’ disease, caused by activating TSH-receptor antibodies, is the most common cause of thyrotoxicosis and accounts for 60–80% of cases. Its prevalence in women is 10-fold higher than in men; its peak occurrence is at age 20–50 years.