Hyperthyroidism

Hyperthyroidism can cause several symptoms that affect your entire body. It is possible to experience more than one symptom at the same time. Some of the common symptoms of hyperthyroidism are:

• Palpitations or rapid heartbeat
• Irregular heartbeat (arrhythmia)
• Unexplained weight loss
• Increased appetite
• Nervousness and irritability
• Trembling in your hands and fingers
• Increased frequency of bowel movements and diarrhea
• Double vision
• Menstrual changes
• Thin skin
• Sleep disorders
• Intolerance to heat
• Excessive sweating
• Enlarged thyroid gland leading to swelling of the neck (goitre)
• Thin, brittle hair
• Bulging of the eyes
• Muscle weakness

Older adults may present with different symptoms that can be mistaken for depression. They are more likely to show either no symptoms or subtle ones such as loss of appetite, heat intolerance, fatigue, or withdrawal from social interactions.

The thyroid gland is a small butterfly-shaped gland in the front of the neck, just below the Adam's apple and above the collarbone. It is stimulated by thyroid-stimulating hormone (TSH) produced by the pituitary to produce two main hormones: T4 (thyroxine) and T3 (triiodothyronine). These hormones play a major role in maintaining important bodily functions including:

• Metabolism (the process that changes food into energy to help the body function)
• Breathing
• Heart rate
• Body temperature

Normally, the body produces the right amount of TSH and thyroxine to regulate normal functioning. However, sometimes the body produces an excess of TSH or the thyroid gland starts producing extra thyroxine, leading to hyperthyroidism.

1. Primary Hyperthyroidism

Primary hyperthyroidism, or thyrotoxicosis, occurs when the disorder lies within the thyroid gland, causing it to produce large amounts of thyroxine. This can be caused by different conditions such as:

• Graves' Disease: The most common cause of hyperthyroidism, Graves’ disease is an autoimmune condition where the immune system overproduces an antibody called thyroid-stimulating immunoglobulin (TSI). This antibody attacks the thyroid gland, stimulating it to produce excessive thyroid hormone. The exact cause of Graves' disease is unknown, but it is a genetic condition that can be passed down in families. Women are more likely to suffer from Graves' disease than men, and it typically presents in individuals between 30 to 50 years of age.
• Thyroid Nodules: A thyroid nodule is a lump or growth of cells in the functioning tissue of the thyroid gland. These nodules may produce more hormone than required, leading to hyperthyroidism. Overactive thyroid nodules are usually large (an inch or more in size) and can often be felt in the neck. Most of these nodules are non-cancerous.
• Thyroiditis: The swelling or inflammation of the thyroid gland is called thyroiditis. When the thyroid gland swells, it leaks excessive hormones, leading to higher levels of thyroid hormones than needed. Symptoms of hyperthyroidism may develop as a result. Thyroiditis can occur due to infections, an immune system disorder, or after childbirth (postpartum thyroiditis). Hyperthyroidism from thyroiditis usually lasts for a few months, and the thyroid typically recovers on its own; however, sometimes it can be damaged, leading to hypothyroidism or an underactive thyroid.
• Iodine: Iodine is a mineral that the thyroid gland uses to produce thyroid hormones. Consuming too much iodine through diet (such as seaweed and seaweed-based supplements) or medications (such as some cough syrups or heart medicine like amiodarone) can result in high thyroid hormone levels. Rarely, iodine dye or intravenous iodinated contrast used for X-ray imaging tests can also cause hyperthyroidism.

2. Secondary Hyperthyroidism

This rare condition arises due to increased stimulation of the thyroid gland by excessive TSH in circulation. It can be caused by a non-cancerous pituitary tumor that overproduces TSH. The hypothalamus produces thyroid-releasing hormone (TRH), which stimulates TSH. Rarely, overproduction of TRH from the hypothalamus can lead to increased levels of TSH.

3. Subclinical Hyperthyroidism

Subclinical hyperthyroidism is characterized by low or undetectable levels of TSH with normal levels of thyroid hormones. It can be caused by medical disorders such as Graves' disease, multinodular toxic goiter (enlarged thyroid gland), and thyroiditis. Medications such as glucocorticoids, amiodarone, and dopaminergic drugs can also induce subclinical hyperthyroidism.

4. Hyperthyroidism in Neonates

This rare condition is observed in neonates of mothers with Graves' disease. In rare cases, hyperthyroidism may occur in the neonates of mothers with a history of treated Graves' disease, indicating a remission in their condition. It can also be seen in newborns of mothers with normal thyroid gland function (euthyroid). An increase in maternal TSH-receptor antibodies can lead to hyperthyroidism in neonates.

• Have a family history of thyroid disorders
• Had thyroid surgery or a thyroid problem such as a goitre (swollen thyroid gland)
• Are a woman
• Are older than 60 years
• Have been pregnant or had a baby in the past 6 months
• Have an underlying chronic illness such as type 1 diabetes, primary adrenal insufficiency (Addison's disease), and pernicious anemia (Vitamin B12 deficiency)
• Are consuming excessive amounts of iodine-containing supplements or medicines
• Have hypothyroidism that is overtreated (overdose of thyroxine medication)

The tests that are essential for diagnosing hyperthyroidism are:

1. Physical examination
   A physical examination entails gently feeling the neck to check for the size of the thyroid gland. The healthcare provider will also examine the skin, eyes, and heart. This helps in detecting tremors, overactive reflexes, and warm, moist skin.
2. Blood tests
   
   • Thyroid stimulating hormone (TSH): This is the most important and sensitive test for hypothyroidism. It measures how much of the thyroxine (T4) hormone the thyroid gland is being asked to make. A low TSH level indicates the presence of hyperthyroidism or an overactive thyroid, suggesting that the thyroid gland is producing excessive hormone, causing the pituitary to stop releasing TSH into the blood. If the TSH levels are not normal, your physician might recommend additional tests to confirm the diagnosis.
   • Thyroxine total (T4): Most of the T4 in the blood is attached to a protein called thyroxine-binding globulin. The "bound" T4 cannot enter body cells. Only about 1%–2% of T4 in the blood is unattached ("free") and can enter cells. The free T4 and the free T4 index are simple blood tests that measure how much unattached T4 is in the blood and available to enter cells. A high blood level of T4 may indicate hyperthyroidism.
   • Thyroxine total (T3): The total T3 includes both bound and free forms circulating in the blood and can be affected by the amount of protein available in the blood to bind to them. The T3 hormone can be measured as free T3 or total T3. The triiodothyronine (T3) total test measures the total levels (both free and bound forms) of T3 hormone in the blood and is usually done as part of the thyroid profile total test. Hyperthyroid patients typically have elevated levels of T3.
   • Along with these three tests, supporting tests may be required to evaluate and monitor the condition, such as:
     • Anti-thyroglobulin antibody
     • Thyroxine binding globulin
3. Imaging tests
   The following imaging tests can be used to find the cause of hyperthyroidism:
   • Thyroid scan: This test evaluates the size, shape, and position of the thyroid gland. It uses a small amount of radioactive iodine to help diagnose the cause of hyperthyroidism and check for thyroid nodules.
   • Ultrasound: Ultrasound of the thyroid is used to closely examine thyroid nodules, which are solid or fluid-filled lumps that form within the thyroid gland. It can also help the doctor evaluate whether the nodules are cancerous.
   • Radioactive iodine uptake test: This test measures how much radioactive iodine the thyroid takes up from the blood after swallowing a small amount. It can help assess thyroid function and identify the cause of hyperthyroidism.

In most cases, there are no known ways to prevent hyperthyroidism. If you have a family predisposition to Graves disease, talk to your physician about getting regular health checkups.

People at a higher risk of hyperthyroidism can make healthier lifestyle choices, such as:

• Having balanced meals
• Exercising regularly
• Avoiding smoking

Hyperthyroidism can be managed through several treatment modalities. The best approach is determined by an individual's age, overall well-being, underlying cause, and severity of the disorder. The treatments include:

• Radioactive iodine therapy: Radioiodine therapy is a common and effective method to treat hyperthyroidism. The patient is asked to take radioactive iodine-131 capsules or liquid orally. It acts solely on the thyroid gland and gradually destroys the thyroid cells that produce thyroid hormone. However, patients undergoing radioiodine therapy may develop hypothyroidism due to the permanent destruction of the thyroid. Hypothyroidism can be managed by taking daily thyroid hormone medications to maintain normal hormone levels. Pregnant or breastfeeding mothers should avoid radioactive iodine, as it can affect the baby's thyroid. Occasionally, a person may experience loss of sensation in their mouth after therapy, which can last for up to a year before returning to normal.
• Antithyroid medications: Antithyroid drugs are the simplest way to manage hyperthyroidism. Doctors most often recommend methimazole. Pregnant women are advised to take propylthiouracil during the first trimester, as methimazole can harm the developing baby. Antithyroid drugs reduce the thyroid gland's hormone production. A patient on antithyroid medication can expect an average treatment duration of 1-2 years, although some may need to continue for several years. This treatment is not a permanent cure but can temporarily alleviate symptoms in patients with Graves' disease. These medications are not used for hyperthyroidism caused by thyroiditis. Potential side effects include allergic reactions, reduced white blood cell count, and, rarely, liver failure.
• Beta-blockers: These drugs block the effects of thyroid hormones on the body but do not stop hormone production. They are used in conjunction with other treatments for long-term management of hyperthyroidism. Beta-blockers work by widening or relaxing blood vessels and can reduce symptoms such as tremors, rapid heartbeat, and nervousness until other treatments take effect. Patients may notice symptom improvement within hours of taking these medications.
• Thyroid surgery: With the advent of radioactive iodine therapy and antithyroid drugs, surgery for hyperthyroidism (thyroidectomy) has become less common. This procedure involves the removal of part or most of the thyroid gland and is recommended for:
  • Pregnant women and children at risk of side effects from antithyroid medications.
  • Individuals with large thyroid glands experiencing issues such as difficulty swallowing, hoarseness, or shortness of breath.
  Removing part of the thyroid may lead to hypothyroidism post-surgery, necessitating lifelong thyroid hormone replacement. Rare complications can include paralysis of the vocal cords and damage to the parathyroid glands, which regulate calcium levels. Accidental removal of parathyroid glands may result in low calcium levels, requiring calcium replacement therapy.
• Radiofrequency ablation (RFA): This is a novel approach for treating thyroid nodules that results in tissue necrosis and nodule shrinkage. RFA is a minimally invasive treatment for benign (non-cancerous) thyroid nodules and is primarily recommended for individuals who have not benefited from medications or surgery.

If you have been prescribed antithyroid medications, take them regularly and on time. The duration of treatment for hyperthyroidism depends on the underlying cause of the disorder. With antithyroid drugs, hormone levels should drop to a manageable level within 6 to 12 weeks. After this period, your doctor might prescribe high doses of non-radioactive iodine drops to normalize thyroid levels within seven to ten days. To remember your medications, consider using labeled containers and setting alarms as reminders. If you have undergone thyroid surgery, closely follow the postoperative instructions provided by your doctor to prevent infections. Additionally, take the prescribed thyroid hormone medications to help maintain your thyroid levels.

Diet

Consuming a wholesome and balanced meal with plenty of vegetables, fruits, and lean protein sources is essential for obtaining necessary nutrients. If you have lost significant weight due to hyperthyroidism, your doctor may recommend a diet that supports healthy weight gain. A low-iodine diet is often advised for individuals with hyperthyroidism, as excessive iodine can exacerbate T4 production. Avoid foods high in iodine, such as:

• Saltwater fish
• Cheese
• Milk
• Eggs
• Kelp
• Seaweed

If you are taking any supplements, ensure they do not contain iodine. Additionally, sodium can contribute to swelling, which is common with Graves’ disease, so it is important to limit salt intake. Untreated hyperthyroidism can weaken bone structure; therefore, consume foods rich in calcium, such as tofu, fortified soy products, or calcium supplements.

Exercise

Regular exercise is beneficial for long-term health, especially for individuals with hyperthyroidism. Mild cardiovascular exercises can help relieve stress and reduce nervousness and irritability associated with the condition. Strength training can also enhance bone density. However, avoid overexertion, as heart rate and metabolic rate are already elevated at rest in untreated hyperthyroidism. Start with low-intensity workouts such as walking, yoga, and tai chi. Engaging with professional trainers experienced in working with patients with medical conditions can also be advantageous. Exercise can aid recovery after thyroid surgery by preventing excess weight gain and controlling appetite.

Stress Management

Hyperthyroidism can increase anxiety and nervousness, and stress may exacerbate symptoms. Effective stress management is crucial in treating hyperthyroidism, particularly in patients with Graves' disease. Consider implementing relaxation techniques, such as:

• Daily meditation
• Taking walks outdoors for fresh air

Nutritional Supplements

Individuals with hyperthyroidism may benefit from supplements such as:

• Vitamin D
• Multivitamins without iodine
• Probiotics
• Omega-3 fatty acids
• Vitamin C
• L-carnitine

It is essential to consult your doctor before adding any supplements to your diet.

Untreated hyperthyroidism can cause several complications that affect different parts of your body, leading to:

• Heart diseases: Hyperthyroidism causes rapid or irregular heartbeat. A rapid heartbeat results from the fast metabolism caused by hyperthyroidism. The body operates faster than normal with an overactive thyroid, leading to the sensation of a racing heart. This increases the risk of medical conditions such as stroke and heart failure.
• Bone disorders: Unchecked levels of thyroid hormones can weaken the skeletal system and make bones brittle. Excessive thyroxine affects the rate of bone replacement and accelerates bone loss. Bone-producing cells (osteoblasts) are unable to replace lost bone at the required rate, potentially resulting in osteoporosis, a condition that causes bones to become weak and fracture.
• Eye and skin problems: Hyperthyroidism caused by Graves' disease affects both the eyes and the skin. It can lead to several eye issues such as bulging eyes, vision loss, redness, swelling, double vision, and light sensitivity. Graves' disease can also cause the skin to become red and swollen, particularly affecting the feet and shins.
• Thyrotoxic crisis (thyroid storm): A thyroid storm is a serious complication of hyperthyroidism, occurring due to a sudden and severe elevation in thyroid hormone levels. This life-threatening condition requires immediate medical attention. The most common symptoms of a thyroid storm include increased body temperature, blood pressure, heart rate, and a sudden change in mental state, such as confusion or lethargy.
• Infertility and complications during pregnancy: Hyperthyroidism can lead to a marked reduction in sperm count in men, affecting fertility. The count typically returns to normal once the thyroid disorder is treated. Women with untreated Graves' disease may experience lighter or irregular periods and face difficulties in conceiving. Hyperthyroidism may also increase the risk of early-term miscarriage and premature birth.

Homoeopathic drugs such as lodium, natrum muriaticum, and lachesis mutus have demonstrated effectiveness in managing hyperthyroidism.

Being diagnosed with hyperthyroidism can cause stress and anxiety, which can lead to further health complications. Patients often struggle with hair loss, nervousness, infertility, and tremors. The long-term outlook for hyperthyroidism depends on the underlying cause of the disorder. However, early diagnosis and treatment, along with good home care, can greatly improve the disease outlook.

1. Maintain a healthy weight
   Increased thyroid levels accelerate the body's metabolism rate and cause unintentional weight loss. Occasionally, patients are pleased with the quick weight loss, but this is not healthy. Consult your doctor to determine a healthy weight for you and consume enough calories to help maintain it.
2. Consume the right diet
   A balanced meal can work wonders for patients with Graves' disease. If you have experienced excessive weight loss due to hyperthyroidism, increasing your food intake can counteract the increase in metabolic rate and help you gain weight. Hyperthyroidism also leads to an increased appetite. It is important to have healthy snacks between meals to satisfy your hunger healthily. Patients with hyperthyroidism should avoid excessive sugar, as the condition speeds up the rate of insulin metabolism, increasing the production and absorption of glucose, which can lead to insulin resistance, especially for diabetic patients.
3. Avoid smoking and secondhand smoke
   Graves' eye disease can develop in patients with Graves' disease. Smoke can worsen this eye condition, so it is essential to avoid smoking and secondhand smoke.
4. Practice yoga and meditation
   Hyperthyroidism is notorious for its effects on mental health, such as anxiety and nervousness. Additional stress from daily situations can aggravate your thyroid symptoms. To counter this, patients with hyperthyroidism should regularly take time to practice calming exercises like yoga and meditation.
5. Take your medications regularly
   It is vital to take your prescribed medications daily and follow your doctor's instructions. To ensure that your hormone levels remain consistent throughout the day, taking the medications at evenly spaced intervals is important. Antithyroid medications take time to work, so it is crucial to adhere to the prescribed medication cycle.