Regulation of thyroid hormones.
Normal: around 20 gm (Contrast: can be as much as 200 gm in Graves) 
TSH goes down before you see an increase in T3, T4. (Lancet Subclinical disease graph)
80 micro of T4 / day. 5 microgram/day : Normal production
Bound to 
THBG (70%)
Pre-albumin (15%) aka Transthyretin
Albumin (15%)
Only 1 % is active form. 
Hyperthryoid 95 % of time, no role of T3. Only about 5 % of hyperthyroid are T3 hyperthyroid. 
T1/2 of 1 week. Hence, no urgency of giving thyroid hormone after surgery unlike adrenectomy. After adrenectomy Hormone replacement has to be quick. 
Antibody.  TSI, TPO, Thyroglobulin ab. 
Clinical Manifestation of Hyperthyroidism: Overt, Subclinical, Apathetic, Storm (or impending storm)
PTU: Only first trimester of pregnancy 
Toxic Hot nodule : RAI treatment ? higher dose than for graves disease? 

Increased uptake
HCG mediated 
Prior to surgery: Iodine can be given as it decreases the vascularity
Graves: No longer total thyroidectomy is done. We do partial thyroidectomy. 
Recurrent Laryngeal Nerve damage. Short, non-mobile, bowed. 
Superior laryngeal nerve damage. More difficult to diagnose. 

Graves Disease 

Clinical Manifestation

DDx of Hyperthyroidism

Evaluation and Monitoring of Graves Disease 

Additional References: 

Thyroid Storm 

Appreciate how hCG causes Hyperthyroidism, and Gynecomastia