In a hyperthyroid patient, serum TSH concentration is below reference range (often unmeasurable), and serum free T4 and/or free T3 concentrations are increased.As a general rule, patients with hyperthyroidism are referred to a specialist in internal medicine for assessment. Start a beta-blocker and also antithyroid medication already at referral to a specialist when the diagnosis of hyperthyroidism is clear. Remember to inform the patient concerning the risk of agranulocytosis associated with antithyroid medication. Patients with thyroid eye disease (in Basedow's [Grave's] disease only) or with pregnancy-induced hyperthyroidism are promptly referred to a specialist. Hyperthyroidism is always treated. In uncertain cases, begin with a beta-blocker only. Depletion of hormone storages that is associated with an inflammatory state is not treated with antithyroid drugs (e.g subacute thyroiditis ). The thyroid gland is palpated in order to estimate its size, whereasultrasonography has no place in the diagnostics of hyperthyroidism.