THINGS YOU NEED TO KNOW ABOUT HYPERTHYROIDISM

Article Updated 5 January 2024

The thyroid gland, a small butterfly shaped gland in the neck produces hormones that govern metabolism, heart rate and body temperature. Hyperthyroidism occurs when there is a disruption in the Thyroid gland function.

In this article, we will discuss everything you need to know about hyperthyroidism, including what it is, what causes it, as well as hyperthyroid symptoms, diagnosis, and treatment.

What Is Hyperthyroidism?

In hyperthyroidism, your thyroid becomes overactive and produces too much thyroid hormone.^[1] When too much of this hormone is produced, the metabolism speeds up, resulting in many symptoms that involve all areas of the body. Most people with hyperthyroidism develop visible thyroid gland enlargement, known as a goiter.

One of Hyperthyroidism's primary symptoms is rapid weight loss, which occurs due to the combination of your body using up too much energy while failing to absorb important nutrients during the digestive process. An overactive thyroid can also lead to a state known as thyrotoxicosis, where all organs of the body receive too much thyroid hormone.

What Causes Hyperthyroidism^[2]?

Hyperthyroidism is most frequently caused by Grave's disease. This is an autoimmune disease that results in the thyroid's white blood cells producing an antibody called Thyroid-stimulating Immunoglobulin (TSI). TSI binds to thyroid stimulating hormone receptors in the thyroid, which triggers them and increases thyroid hormone release. It also causes the immune system to target healthy thyroid cells, which stimulates more thyroid hormone to be produced within the gland.^[3] 

Other common causes of hyperthyroidism include:

• Hyperfunctioning thyroid nodules or overgrowths of normal thyroid tissue that can grow large enough to be seen or felt outside of the body. These are some of the most common causes of goiters. They are initially benign in nature but can become cancerous in time.
• Thyroiditis is an inflammation of the thyroid gland that increases the production and release of thyroid hormone. Thyroiditis is most commonly associated with autoimmune conditions such as Hashimoto’s thyroiditis and medications. Toxic adenoma is another possible cause of hyperthyroidism. It refers to a benign tumor on the thyroid gland that produces excess thyroid hormones.
• Excessive iodine intake: Iodine is used by the body to make thyroid hormone. Consuming too much iodine for 2-12 weeks, either through diet or supplements, can cause the thyroid gland to produce excess hormones and lead to an overactive thyroid.
• Medications: Certain medications can cause the thyroid gland to produce too much hormone. Amiodarone is a heart medication that stabilizes the heart rate. It is famous for promoting an overactive thyroid due to its high iodine content.^[4] Lithium and various chemotherapies such as tyrosine kinase inhibitors, interferon-alpha, and immune checkpoint inhibitors can also increase hyperthyroidism risk.

Risk Factors

Risk factors for hyperthyroidism include:

• Gender: Women are more likely to develop hyperthyroidism than men. The condition is more common in women between the ages of 20 and 40.
• Family History: Having a family history of thyroid disorders, such as Graves' disease, increases the risk of developing hyperthyroidism.
• Autoimmune Disorders: A higher chance of developing hyperthyroidism is linked to a number of inflammatory conditions, including rheumatoid arthritis, Type 1 diabetes, and pernicious anemia.
• Stress: Persistent stress may aggravate pre-existing symptoms of hyperthyroidism or aid in its development.
• Pregnancy: Pregnancy-related changes in hormone levels can trigger hyperthyroidism in some women. It usually resolves after delivery, but it may require treatment during pregnancy to prevent complications.
• Radiation Exposure: Previous exposure to radiation, particularly to the head and neck area, increases the risk of developing hyperthyroidism.

Excessive iodine consumption and various medications known to cause hyperthyroidism can also increase the risk of contracting the condition.

It is crucial to remember that a person does not automatically acquire hyperthyroidism just because they have one or more risk factors. These factors only increase the likelihood of developing the condition.

For an accurate diagnosis and course of treatment, it is advisable to speak with a healthcare provider if you have any concerns or think you may have hyperthyroidism.

Hyperthyroidism Signs and Symptoms

Signs and symptoms of hyperthyroidism include^[5]:

• Irritability or nervousness
• Mood swings
• Fatigue or muscle weakness
• Intolerance to heat
• Sleep disturbances and insomnia
• Thinning of the skin
• Fine or brittle hair
• Tremors in the hands
• Rapid heartbeat (tachycardia) or irregular heartbeat (arrhythmia)
• Palpitations
• Unintentional weight loss
• Extensive sweating
• Frequent bowel movements or diarrhea
• Hyperreflexia (overactive reflexes)
• Increased appetite

Women who have hyperthyroidism typically experience symptoms that are similar to those in men. However, women may also experience changes in their menstrual cycle as a symptom of hyperthyroidism.

If you have any symptoms, it is crucial to see a doctor for an appropriate diagnosis and course of treatment.

Complications of Hyperthyroidism

Untreated hyperthyroidism can result in major complications^[6], including:

• Osteoporosis: Excess thyroid hormones can cause bone loss, leading to osteoporosis.
• Heart problems: Hyperthyroidism can cause an irregular heartbeat, high blood pressure, and an increased risk of heart attack and stroke.
• Eye problems: The immune system targets the tissues surrounding the eyes in Graves' disease, resulting in inflammation and the eyeballs protruding from their sockets (Graves ophthalmopathy). Patients with Graves' disease frequently have blurred vision, dry eyes, copious tears, sensitivity to light, and red or puffy eyes from inflammation.
• Premature birth: Studies have suggested a link between hyperthyroidism during pregnancy and an increased risk of premature birth. Individuals with autoimmune thyroid diseases generate antithyroid antibodies that have the ability to pass through the placenta and impact the developing fetus. It is important for pregnant women with hyperthyroidism to receive appropriate medical care and monitoring.
• Thyroid storm or Thyrotoxic crisis: Thyroid storm is a rare but potentially fatal illness that can result from hyperthyroidism characterized by a sudden and severe increase in thyroid hormones and hyperthyroid symptoms.

The risk of complications increases the longer treatment is delayed, including heart problems, stroke, osteoporosis, and a thyrotoxic crisis. Early diagnosis of hyperthyroidism is important to prevent or minimize these complications with appropriate treatment.

How Is Hyperthyroidism Diagnosed?

Your doctor will examine you physically and inquire about your symptoms in order to make the hyperthyroidism diagnosis. To find out thyroid levels in your body, they could also prescribe blood tests. These examinations may also be used to identify the causes of hyperthyroidism.

The following blood tests are commonly used for the diagnosis of hyperthyroidism:

• Thyroid Hormone Panel: This blood test measures the levels of various thyroid hormones, including TSH (thyroid stimulating hormone), free thyroxine (T4), and triiodothyronine (T3). Low TSH coupled with high FT4 and T3 usually indicates an overactive thyroid.
• Thyroid Antibody Tests: These tests detect the presence of antibodies that may be causing the hyperthyroidism. The two most common thyroid antibodies tested are thyroid-stimulating immunoglobulin (TSI) and thyroid peroxidase antibody (TPOAb). Either of these indicate an autoimmune hyperthyroid condition.

Imaging tests that may be used to confirm the cause of hyperthyroidism include a thyroid scan and ultrasound.

A thyroid X-ray scan involves the use of a small amount of radioactive material that is injected into a vein. The material travels through the bloodstream and is taken up by the thyroid gland. An X-ray device is then used to create images of the thyroid gland, which can help identify any abnormalities or nodules that may be causing the hyperthyroidism.

Ultrasound imaging uses high-frequency sound waves to produce images of the thyroid gland. This non-invasive test can identify any nodules or other anomalies and assist in visualizing the gland's size, shape, and structure.

A biopsy may also be performed to check for thyroid cancer.

If a thyroid nodule or Graves' disease is the underlying cause of hyperthyroidism, these tests can offer important information to assist in identifying it. Yet, based on each case's unique circumstances and the hypothesized etiology of hyperthyroidism, the specific imaging studies might differ.

Available Treatment

The cause and severity of hyperthyroidism determine how the condition is treated. Typical treatment options include the following^[7]:

Medications

Methimazole and Propylthiouracil are anti-thyroid medicines that can aid in lowering thyroid hormone production. These medications are often used to treat Graves' disease and can also be used to prepare for other treatments, such as radioactive iodine therapy or surgery.

Patients often experience improvement after several weeks to months and are taken off medications within 12-18 months. Remission is possible with antithyroid medications for some individuals. However, symptoms may reappear after treatment ends for others.

Their side effects are minimal, with the most common one being the development of a rash. In rare cases, propylthiouracil has been known to cause liver damage. As a result, methimazole is more often used.

Radioactive Iodine Therapy

Radioactive iodine is the most common treatment in the United States. It is often used for people with Graves' disease or thyroid nodules.

It is a non-invasive treatment where radioactive iodine taken in pill or liquid form is absorbed by the thyroid gland. The radiation gradually shrinks and destroys the cells in the thyroid gland, reducing its ability to produce hormones.

Hyperthyroidism can be resolved with a single dose in most cases^[8], although it might take a few weeks to several months. A second dosage may be required if symptoms persist after 6 months. However, hypothyroidism is one potential side effect of this medication.

Thyroidectomy

In some cases, surgery may be recommended to remove all or part of the thyroid gland. This is often done for people with large thyroid nodules or those who do not respond to other treatments.

Drawbacks to thyroid surgery are any potential complications during anesthesia and the possibility of heavy bleeding and damage to the laryngeal nerves that attach to the vocal cords. There is also a risk that parathyroid glands will be compromised, affecting the body’s production of calcium.

Beta-Blockers

Medications known as beta-blockers help manage hyperthyroidism symptoms like tremors and an increased heart rate. They do not treat the underlying cause of hyperthyroidism but can provide relief from symptoms while other treatments take effect. Beta-blockers can take 3-4 weeks for the effects to take place and need to be tapered off when discontinued.

Prevention of Hyperthyroidism

Hyperthyroidism cannot be completely prevented. However, there are a few steps that you can take to minimize your risk:

• Limit your iodine intake: Excess hormone production by the thyroid gland might result from an excessive iodine intake. Avoid taking iodine supplements and limit your intake of iodine-rich foods, such as seaweed, iodized salt, and dairy products.
• Quit smoking: Smoking can increase your risk of developing Graves' disease, so quitting smoking can help reduce your risk of hyperthyroidism.
• Manage stress: Stress can trigger the symptoms of hyperthyroidism, so it is important to find ways to manage stress, such as practicing relaxation techniques or seeking therapy.
• Restrict radiation exposure: Try not to expose the head and neck areas to too much radiation. This includes cellphone radiation. If at high risk for developing hyperthyroidism, it may be beneficial to use a loudspeaker when taking calls.
• Lead a healthy lifestyle: Regular exercise and a healthy diet plan can go a long way towards keeping the immune system balanced and lowering bodily inflammation. This can help to prevent thyroiditis and keep the risk of hyperthyroidism to a minimum.

Conclusion

Hyperthyroidism is a common condition that can have serious consequences if left untreated. It is imperative to see a physician if you encounter any hyperthyroidism symptoms so that you can receive the appropriate diagnosis and care. You can successfully manage your hyperthyroidism and lead an active, healthy life with the right treatment.

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