Hyperthyroidism

1. Overview of the illness

Hyperthyroidism occurs when your thyroid - the butterfly-shaped gland at the bottom of
your neck, just above your collarbone - produces and releases more hormones than your
body requires. This is also known as an overactive thyroid. The specific hormones that
the thyroid produces are Triiodothyronine and thyroxine. Such hormones regulate how
the body uses energy, thus they have an impact on practically every organ in the body,
including the rate at which your heart beats. With this disease, many of your body's
activities speed up since you have too much thyroid hormone.

Hyperthyroidism can really impact ones entire body and is a medical issue that requires
medical attention.

Hyperthyroidism is when your thyroid -- -- makes too much of a hormone called thyroxine.

2. Causes

A.
Hyperthyroidism can be caused by a number of conditions, including Graves' disease,
Plummer's disease and thyroiditis.

Your thyroid gland produces two main hormones, thyroxine (T4) and triiodothyronine
(T3), that influence every cell in your body. They maintain the rate at which your body
uses fats and carbohydrates, help control your body temperature, influence your heart
rate, and help regulate the production of protein. Your thyroid also produces a hormone
that helps regulate the amount of calcium in your blood (calcitonin).

Reasons for too much thyroxine (T4)

Normally, your thyroid releases the right amount of hormones, but sometimes it
produces too much T4. This may occur for a number of reasons, including:
 Graves' disease. Graves' disease is an autoimmune disorder in which
antibodies produced by your immune system stimulate your thyroid to
produce too much T4. It's the most common cause of hyperthyroidism.
 Hyperfunctioning thyroid nodules (toxic adenoma, toxic multinodular
goiter or Plummer's disease). This form of hyperthyroidism occurs when
 one or more adenomas of your thyroid produce too much T4. An adenoma
is a part of the gland that has walled itself off from the rest of the gland,
forming noncancerous (benign) lumps that may cause an enlargement of
the thyroid.
 Thyroiditis. Sometimes your thyroid gland can become inflamed after
pregnancy, due to an autoimmune condition or for unknown reasons. The
inflammation can cause excess thyroid hormone stored in the gland to leak
into your bloodstream. Some types of thyroiditis may cause pain, while
others are painless.

Risk factors
Risk factors for hyperthyroidism, include:
 A family history, particularly of Graves' disease
 Female sex
 A personal history of certain chronic illnesses, such as type 1 diabetes,
pernicious anemia and primary adrenal insufficiency

B.
Medical conditions and situations that can cause hyperthyroidism include:

 Graves’ disease: In this disorder, your immune system attacks your thyroid. This
makes your thyroid create too much thyroid hormone. Graves’ disease is a
hereditary condition (passed down through a family). If a member of your family
has Graves’ disease, there’s a chance others in the family could have it, too. It’s
more common in people assigned female at birth than people assigned male at
birth. Graves’ disease is the most common cause of hyperthyroidism, making up
about 85% of cases.
 Thyroid nodules: A thyroid nodule is a lump or growth of cells in your thyroid
gland. They can produce more hormones than your body needs. Thyroid nodules
are rarely cancerous.
 Thyroiditis: Thyroiditis is inflammation of your thyroid gland, which may be
painful or painless (silent). It may happen within a year of delivering a baby
(postpartum thyroiditis). After you experience thyroiditis, your thyroid may be
unable to recover, which would lead to hypothyroidism.
 Consuming excess iodine: If you’re at risk for hyperthyroidism and consume
too much iodine (through your diet or medications), it can cause your thyroid to
produce more thyroid hormone. Iodine is a mineral that your thyroid uses to
create thyroid hormone. Receiving intravenous iodinated contrast (iodine “dye”)
may also cause hyperthyroidism. Amiodarone, a medication that contains a high
amount of iodine, may also cause hyperthyroidism.
 C.
Hyperthyroidism has several causes, including

 Graves’ disease
 overactive thyroid nodules
 inflammation of the thyroid gland, called thyroiditis
 too much iodine NIH external link
 too much thyroid hormone medicine
 a noncancerous tumor of the pituitary gland

Graves’ disease

Graves’ disease, the most common cause of hyperthyroidism, is an autoimmune

disorder. With this disease, your immune system attacks the thyroid and causes it to
make too much thyroid hormone.

Overactive thyroid nodules

Overactive thyroid nodules, or lumps in your thyroid, are common and usually not
cancerous. However, one or more nodules may become overactive and produce too
much thyroid hormone. Overactive nodules are found most often in older adults.

Thyroiditis

Thyroiditis is inflammation of your thyroid gland. Some types of thyroiditis can cause
thyroid hormone to leak out of your thyroid gland into your bloodstream. As a result, you
may develop symptoms of hyperthyroidism.

The types of thyroiditis that can cause hyperthyroidism include

 subacute thyroiditis, which involves a painfully inflamed and enlarged thyroid.

 postpartum thyroiditis, which can develop after a woman gives birth.
 painless thyroiditis, which is similar to postpartum thyroiditis, but occurs in the
absence of pregnancy. Your thyroid may be enlarged. Experts think painless
thyroiditis is probably an autoimmune condition.

Thyroiditis can also cause symptoms of hypothyroidism, or underactive thyroid. In some

cases, after your thyroid is overactive for a period of time, it may become underactive.

Too much iodine

Your thyroid uses iodine to make thyroid hormone. How much iodine you consume
affects how much thyroid hormone your thyroid makes. In some people, consuming
large amounts of iodine may cause the thyroid to make too much thyroid hormone.

Some cough syrups and medicines, including some heart medicines, may contain a lot
of iodine. Seaweed and seaweed-based supplements also contain a lot of iodine.

Too much thyroid hormone medicine

Some people who take thyroid hormone medicine for hypothyroidism may take too
much. If you take thyroid hormone medicine, see your doctor at least once a year
to have your thyroid hormone levels checked. You may need to adjust your dose if your
doctor finds your thyroid hormone level is too high.

Some other medicines may also interact with thyroid hormone medicine and raise
hormone levels. If you take thyroid hormone medicine, ask your doctor about
interactions when starting new medicines.

Noncancerous tumor

In some rare cases, a noncancerous tumor of the pituitary gland, located at the base of
the brain, can cause hyperthyroidism.

D.
Several conditions can cause hyperthyroidism.
Graves’ disease. This immune system disorder is the most common cause of
hyperthyroidism (70% of cases). Normally, the antibodies in your blood go after bacteria,
but if you have Graves’ disease, the antibodies turn on your thyroid instead. This causes
the gland to make too much T-4 and T-3 thyroid hormone. Doctors aren’t sure why some
people get Graves’ disease, but it tends to run in families. It’s more likely to affect women
under the age of 40.
Thyroid nodules (Plummer’s disease). These lumps of tissue in your thyroid can
become overactive, creating too much thyroid hormone. Plummer’s disease is more
common in older people.
Thyroiditis. An infection or an immune system problem can cause your thyroid to swell
and leak hormones into your bloodstream. With this condition, your thyroid is swollen for no
clear reason. This is often followed by hypothyroidism, in which your thyroid doesn’t make
enough hormones. These conditions are usually temporary. Thyroiditis can happen:

 After pregnancy
 When you get a virus or another problem with your immune system
 If you take too much thyroid medication
You can also get hyperthyroidism if you get lots of iodine in your diet (like in a medication or
supplement) or from taking too much thyroid hormone medication.

Thyroid Eye Disease

About 30% of people with Graves’ disease get a condition called thyroid eye disease. It
involves your vision and eyes, including the muscles and tissues around them. Symptoms
include:

 Bulging eyes
 A gritty feeling, pain, or pressure in your eyes
 Redness or inflammation in or around your eyes
 Eyelids that are puffy or pulled back
 Sensitivity to light
 Double vision or loss of vision

People with Graves’ disease may also get a rare condition called Graves’ dermopathy. It
can cause redness and thickening of your skin, usually on the tops of your feet or your
shins.

3. Symptoms
A.
Hyperthyroidism can mimic other health problems, which can make it difficult for your
doctor to diagnose. It can also cause a wide variety of signs and symptoms, including:
 Unintentional weight loss
 Rapid heartbeat (tachycardia)
 Irregular heartbeat (arrhythmia)
 Pounding of your heart (palpitations)
 Increased appetite
 Nervousness, anxiety and irritability
 Tremor — usually a fine trembling in your hands and fingers
 Sweating
 Changes in menstrual patterns
 Increased sensitivity to heat
 Changes in bowel patterns, especially more frequent bowel movements
 An enlarged thyroid gland (goiter), which may appear as a swelling at the
base of your neck
 Fatigue, muscle weakness
 Difficulty sleeping
 Skin thinning
 Fine, brittle hair
Older adults are more likely to have either no signs or symptoms or subtle ones, such
as an increased heart rate, heat intolerance and a tendency to become tired during
ordinary activities.

B.
Symptoms of hyperthyroidism can vary from person to person and may include 4
 weight loss despite an increased appetite
 rapid or irregular heartbeat
 nervousness, irritability, trouble sleeping, fatigue
 shaky hands, muscle weakness
 sweating or trouble tolerating heat
 frequent bowel movements 
 an enlargement in the neck, called a goiter

In older adults, hyperthyroidism is sometimes mistaken for depression NIH external

link or dementia NIH external link. Older adults may have different symptoms, such as
loss of appetite or withdrawal from people, than younger adults with hyperthyroidism.
You may want to ask your doctor about hyperthyroidism if you or your loved one shows
these symptoms.

C.
Common signs include:

 Nervousness, anxiety, or crankiness

 Mood swings
 Fatigue or weakness
 Sensitivity to heat
 A swollen thyroid (called a goiter). You might see swelling at the base of your
neck.
 Losing weight suddenly, without trying
 Fast or uneven heartbeat or palpitations (pounding in your heart)
 Having more bowel movements
 Shaking in your hands and fingers (tremor)
 Sleep problems
 Thinning skin
 Fine, brittle hair
 Changes in your menstrual cycle

If you’re an older adult, you’re more likely to have subtle symptoms like a faster heart
rate or being more sensitive to warm temperatures. Or you could just feel more tired
after everyday activities.
Certain medicines can mask the signs of hyperthyroidism. If you take beta-blockers to
treat high blood pressure or another condition, you might not know you have it. Be sure
your doctor knows about all the medications you take.
When you first get hyperthyroidism, you may feel energetic. This is because
your metabolism is sped up. But over time, this increase in your metabolism can break
your body down and cause you to feel tired.
Usually, hyperthyroidism develops slowly. If you’re young when you get it, the
symptoms might come on suddenly.

4. Complications
A.
Hyperthyroidism can lead to a number of complications:

 Heart problems. Some of the most serious complications of

hyperthyroidism involve the heart. These include a rapid heart rate, a heart
rhythm disorder called atrial fibrillation that increases your risk of stroke, and
congestive heart failure — a condition in which your heart can't circulate
enough blood to meet your body's needs.

 Brittle bones. Untreated hyperthyroidism can also lead to weak, brittle

bones (osteoporosis). The strength of your bones depends, in part, on the
amount of calcium and other minerals they contain. Too much thyroid
hormone interferes with your body's ability to incorporate calcium into your
bones.

 Eye problems. People with Graves' ophthalmopathy develop eye problems,

including bulging, red or swollen eyes, sensitivity to light, and blurring or
double vision. Untreated, severe eye problems can lead to vision loss.

 Red, swollen skin. In rare cases, people with Graves' disease develop
Graves' dermopathy. This affects the skin, causing redness and swelling,
often on the shins and feet.

 Thyrotoxic crisis. Hyperthyroidism also places you at risk of thyrotoxic

crisis — a sudden intensification of your symptoms, leading to a fever, a
rapid pulse and even delirium. If this occurs, seek immediate medical care.

B.
Thyroid storm (thyroid crisis or thyrotoxic crisis) is a rare but serious complication of
hyperthyroidism. It happens when your thyroid makes and releases a large amount of
thyroid hormone in a short amount of time. Thyroid storm is a life-threatening
emergency that requires immediate medical attention.

Symptoms of thyroid storm include:

 High fever — a temperature between 104 degrees to 106 degrees Fahrenheit is

common.
 Rapid heart rate (tachycardia) that can exceed 140 beats per minute.
 Feeling agitated, irritable and/or anxious.
 Delirium.
 Congestive heart failure.
 Loss of consciousness.

A complication of Graves’ disease, one of the causes of hyperthyroidism, is called

Graves’ eye disease (Graves’ ophthalmopathy). This condition can usually not be
prevented. Graves’ eye disease can cause the following complications:

 Bulging eyes.
 Vision loss.
 Double vision.
 Light sensitivity.

C.
Untreated, hyperthyroidism can cause serious health problems, including

 an irregular heartbeat that can lead to blood clots, stroke, heart failure, and

other heart-related problems
 an eye disease called Graves’ ophthalmopathy
 thinning bones, osteoporosis NIH external link, and muscle problems
 menstrual cycle and fertility issues

5. Treatment

A.
Several treatments for hyperthyroidism exist. The best approach for you depends on
your age, physical condition, the underlying cause of the hyperthyroidism, personal
preference and the severity of your disorder. Possible treatments include:
 Radioactive iodine. Taken by mouth, radioactive iodine is absorbed by
your thyroid gland, where it causes the gland to shrink. Symptoms usually
subside within several months. Excess radioactive iodine disappears from
the body in weeks to months.

This treatment may cause thyroid activity to slow enough to be considered

underactive (hypothyroidism), and you may eventually need to take
medication every day to replace thyroxine.

 Anti-thyroid medications. These medications gradually reduce symptoms

of hyperthyroidism by preventing your thyroid gland from producing excess
amounts of hormones. They include methimazole (Tapazole) and
propylithiouracil. Symptoms usually begin to improve within several weeks
to months, but treatment with anti-thyroid medications typically continues at
least a year and often longer.

For some people, this clears up the problem permanently, but other people
may experience a relapse. Both drugs can cause serious liver damage,
sometimes leading to death. Because propylthiouracil has caused far more
cases of liver damage, it generally should be used only when you can't
tolerate methimazole.

A small number of people who are allergic to these drugs may develop skin
rashes, hives, fever or joint pain. They also can make you more susceptible
to infection.

 Beta blockers. Although these drugs are usually used to treat high blood
pressure and don't affect thyroid levels, they can ease symptoms of
hyperthyroidism, such as a tremor, rapid heart rate and palpitations. For that
reason, your doctor may prescribe them to help you feel better until your
thyroid levels are closer to normal. These medications generally aren't
recommended for people who have asthma, and side effects may include
fatigue and sexual dysfunction.

 Surgery (thyroidectomy). If you're pregnant or you otherwise can't tolerate

anti-thyroid drugs and don't want to or can't have radioactive iodine therapy,
you may be a candidate for thyroid surgery, although this is an option in only
a few cases.
 In a thyroidectomy, your doctor removes most of your thyroid gland. Risks of
this surgery include damage to your vocal cords and parathyroid glands —
four tiny glands situated on the back of your thyroid gland that help control
the level of calcium in your blood.

In addition, you'll need lifelong treatment with levothyroxine (Levoxyl,

Synthroid, others) to supply your body with normal amounts of thyroid
hormone. If your parathyroid glands also are removed, you'll need
medication to keep your blood-calcium levels normal

In here , your doctor will remove the majority of your thyroid gland. Some of
the risks involved in here are vocal and parathyroid glands damage (four
tiny glands that help control the level of calcium in your blood).

Furthermore, you'll also need to take levothyroxine for the rest of your life to
keep your thyroid hormone levels in check. You'll also need medicine to
keep your blood calcium levels regular if your parathyroid glands are also
removed.

B.
With most treatments, there are also risks of side effects. It’s important to talk to your
healthcare provider and weigh all of the advantages and disadvantages before deciding
on a treatment plan. Some of these risks include:

 Medication side effects: The two medications that can treat hyperthyroidism are
methimazole and propylthiouracil (PTU). These drugs can cause several side
effects. One rare side effect that affects less than 1% of people is potential liver
damage, which may be permanent in the case of PTU. Another rare (less than
1%) but serious side effect is agranulocytosis (severe drop in white blood cell
count). These side effects can happen to people of any age. In pregnant people,
this medication can pass from parent to baby through the placenta. This could
cause hypothyroidism or the development of a goiter in the unborn baby.
Pregnant people are closely monitored because of this side effect. There’s also a
possibility of an allergic reaction to these medications, which occurs in about 5%
of people.
 Radioactive materials: Whenever radiation is involved, there’s a possible side
effect of cancer. Currently, there’s no link between using radioactive iodine to
treat hyperthyroidism and developing cancer. This is considered low-risk and
unlikely. One risk that is known is between a pregnant or breastfeeding person
and their baby. You shouldn’t take radioactive iodine while pregnant or
 breastfeeding because it can affect your baby’s thyroid gland. Sometimes, you
can lose sensation in your mouth after radioactive iodine (RAI) therapy. This is
common. But don’t worry — even though it can last for up to a few months, the
sensation does come back to your mouth over time.
 Surgery: There are always certain risks linked to surgery, like infection and
bleeding. Surgery is generally considered a very effective treatment for
hyperthyroidism. In rare situations, complications like paralysis of the vocal cords
(inability to speak) and damage to your parathyroid glands can happen, which
results in low calcium in your blood.

After treatment, you’ll most likely need to take replacement thyroid hormone for the rest
of your life. This is because some of these treatments — especially surgery — reduce
your thyroid hormone levels to very low levels or eliminate this hormone by removing
your thyroid. You’ll need to reintroduce the thyroid hormones back into your system by
taking regular medication.

C.
Your doctor will help you decide on a treatment based on your age, your overall health,
the kind of hyperthyroidism you have, and how severe it is. Your options might include:
Antithyroid drugs. Methimazole (Tapazole) and propylthiouracil (PTU) block your
thyroid from making too many hormones. These medicines will typically ease your
symptoms within weeks or a few months, although you will probably need to stay on
them for up to 18 months to help lessen the chance of a relapse. Methimazole has less-
severe side effects, so it’s prescribed more often. Side effects include allergic reactions
like rash or itching. Up to 3% of people who take antithyroid medications have allergic
reactions. It’s rare, but these drugs can also cause your body to make fewer white blood
cells, a condition called agranulocytosis. This makes you more likely to get infections.
Rarely, these medicines can damage your liver, so call your doctor right away if you
have symptoms like yellow skin or eyes, fatigue, a fever, sore throat, or pain in your
belly.
Beta-blockers. These medications don’t treat your levels of thyroid hormone but can
help with symptoms like anxiety, shaking, or a fast heartbeat. Beta-blockers affect the
way thyroid hormone acts on your body. They’re most often used to treat high blood
pressure. Side effects may include:

 Headache
 Dizziness
 Digestive problems

Radioactive iodine. You swallow a small amount of radioactive iodine. Overactive

thyroid cells absorb it, and it destroys them. This makes your thyroid shrink and your
levels of thyroid hormone go down. You might need to have this treatment more than
once. Because taking this medication makes your thyroid slow down, it may also cause
hypothyroidism. This is easier to treat than hyperthyroidism: You’ll take a hormone
supplement once a day. It usually takes 3 to 6 months to work. Doctors have used
radioactive iodine to treat hyperthyroidism for over 60 years. It’s generally considered
safe, and it’s used to treat more than 70% of adults with hyperthyroidism.
Surgery. If medications aren’t a good option for you, your doctor may remove all or part
of your thyroid. This is called thyroidectomy. You might need to take antithyroid
medicines before the surgery to prevent complications. Afterward, you might have
hypothyroidism and need to take a hormone supplement. If your parathyroid glands are
also removed, you may need medication to keep the calcium levels in your blood where
they should be.
This surgery comes with some risks. It can damage your vocal cords and
your parathyroid glands

6. How to avoid/prevent

Can hyperthyroidism be prevented or avoided?

You cannot prevent hyperthyroidism. However, some people are more at risk for the
condition. This includes people who:
 Were born female.
 Have a family history of thyroid disease.
 Are younger than 40 or older than 60.
 Have certain problems, such as type 1 diabetes, pernicious anemia, or an
immune system disorder.
 Consume large amounts of iodine, either through food or medicine
© https://familydoctor.org/condition/hyperthyroidism/

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