Home > Health Topics > Hyperthyroidism
 Definition | Causes | Symptoms | Diagnosis | Treatment | Prevention References
Hyperthyroidism : Diagnosis
Western Medicine Chinese Medicine

If hyperthyroidism is suspected, its diagnosis is easy to confirm. This is done by demonstrating the presence in the blood circulation of high concentrations of free thyroid hormones, T3 and T4.

Measurement of the level of thyroid stimulating hormone (TSH) in the blood is also carried out, as a low blood TSH level (resulting from negative feedback) will indicate that the thyroid gland is over-productive. This test also allows a differential diagnosis to be made between hyperthyroidism and pituitary tumor.

The measurement of the TSH level is invariably carried out in the elderly as physiologic changes and other illnesses can interfere with the interpretation of T3 and T4 levels.

The measurement of radioactive iodine or technetium uptake by the thyroid gland is also sometimes employed in the diagnosis of Graves' disease, especially if the symptoms peculiar to the disorder (diffuse goiter, discoloration of the lower leg and staring/bulging eyes) are not present. An injection of the mildly radioactive material is made into the blood stream and the thyroid gland is then scanned to determine how much material has been taken up. The radiation dose is extremely small and produces no side effects. Diagnostic radioactive iodine can also be given by mouth.

99mTechnetium scan of patient with Graves' disease showing diffuse uptake of isotope

Other biochemical abnormalities associated with hyperthyroidism include abnormal liver function tests, mildly raised blood levels of calcium and sugar in the urine.

Although it is fairly easy to make a clinical diagnosis of hyperthyroidism on signs and symptoms alone, it is essential to confirm the diagnosis in the laboratory. Thyroid function tests may need to be repeated more than once and treatment will depend on their results.




Diagnosis in TCM places importance on determining the circumstances and manifestations of a disease through inquiry and symptom observation. Diagnosis is based on the traditional four examination techniques:

1. Questioning The TCM practitioner will establish the medical history of both the patient and his family.
2. Observation Examination of the physical features of the body, such as the face, tongue, hair, nails, sputum (mucus that is coughed up), and location of pain, all offer clues to the problem. The tongue is a particularly useful indicator of the functioning of the internal organs.
3. Listening and smelling The smelling of sputum and breath and listening to the sounds produced by the chest offer additional clues to the patient's health.
4. Touching Feeling the pulse is a cornerstone of TCM diagnosis and gives the practitioner much information about any bodily imbalance.

In hyperthyroidism, the procedures used in TCM to differentiate between disharmony patterns can be explained as follows:

Liver-qi stagnation, spleen deficiency and phlegm accumulation
When the liver fails to regulate the qi circulation, the spleen becomes damaged, digestion and absorption are affected, and phlegm evil is generated. Individuals present with liver symptoms, such as depression, discomfort in the chest and around the ribs, and protrusion of the eyes. Related digestive symptoms include poor appetite, fullness after meals or nausea, weight loss and fatigue.

On examination, the tongue is swollen, pink in color and indented on the margins. The tongue fur is white and greasy. The pulse is taut and fine, or fine and slippery.

Swollen, pink and indented tongue

Deficiency in both qi and yin
Stagnation of the liver-qi generates a lot of fire evil and this in turn depletes the qi and yin inside the body affecting other organs. For example, deficiency of heart-yin leads to palpitation, insomnia and irritability. When the spleen is deficient, insufficient protective-qi and nutrients are produced for the skin and muscles, and sweating, emaciation, fatigue and weakness occur.

On examination, the tongue is red with a coating of thin yellow fur. The pulse is fine and rapid.

Yin-deficiency and yang-hyperactivity
Stagnation of qi also results in liver-yang hyperactivity and a change in the emotional state. Heart-yin deficiency leads not only to palpitation and insomnia, but also to sweating and nightmares. When the stomach is damaged by liver-generated fire evil, individuals tend to have an increased appetite, become readily hungry and thin. The wind evil causes hand and finger tremor. Accumulation of virtual fire, which results from a relative excess of yang, causes an aversion to heat. The individual becomes thirsty and has a flushed face and blood-shot eyes.

On examination, the tongue is red. The pulse is taut and rapid, or fine and rapid.

If a TCM practitioner suspects a serious problem that cannot be treated by Chinese medicine alone, he or she will recommend the individual to see a Western doctor for further follow-up.