Hyperthyroidism

Hyperthyroidism, also known as overactive thyroid, occurs when there is overproduction of thyroid hormones by the thyroid gland. It is also referred to as thyrotoxicosis. The thyroid gland located in the front of the neck, below the larynx, produces hormones that control many of the body’s important functions. Excess thyroid hormone speeds up your metabolism and impacts your entire body.

Symptoms

Usually symptoms go unnoticed for a long time, but in some patients these changes are sudden. Common symptoms include:

• Weight loss despite a good appetite
• Rapid heart beat
• Increased sensitivity to heat
• Hand tremors
• Fatigue
• Increased sweating
• Irregular menstrual periods
• Muscle weakness
• Nervousness
• Irritability

People with grave’s disease have additional symptoms. The most common symptom is swollen eyes.

Causes

The causes of overactive thyroid include:

• Grave’s Disease: Grave’s disease, an autoimmune disease, is the most common cause of hyperthyroidism. In grave’s disease, the immune system produces an antibody that stimulates the thyroid to produce too much thyroid hormone, causing symptoms of hyperthyroidism. Over time the thyroid gland enlarges and forms a thyroid goiter. When the immune system attacks the muscles and fatty tissues around and behind the eyes it causes the classic swollen eyes of thyroid eye disease. This type of hyperthyroidism tends to run in families and occurs most often in young women.
• Toxic nodular/ multinodular goiter: It is characterized by the presence of one or more nodule in the thyroid. These nodules become overactive and produce too much thyroid hormone. It occurs most often in older adults.
• Thyroiditis: This is caused due to the problem with the immune system or viral infection. The thyroid becomes temporarily inflamed and releases thyroid hormone into the bloodstream.
• Hyperthyroidism can also be caused by taking too much thyroid hormone in tablet form.

Diagnosis

Hyperthyroidism can be diagnosed with the blood test and physical examination. Your doctor may check for certain signs such as an enlarged thyroid gland, rapid pulse, eye changes and moist skin. Blood test measures the level of thyroid hormone and thyroid stimulating hormone (TSH). A high level of thyroxine along with low level of TSH is a clear indication of hyperthyroidism.

A thyroid scan may also be recommended to help find the cause. The test will find out if your entire thyroid gland is overactive or whether you have a toxic nodular goiter. If your entire thyroid gland is affected, then you have Grave’s disease. If not, the doctor will look for the toxic nodular goiter.

Treatment

There are several treatment options. The treatment depends upon the age, severity, and type of hyperthyroidism. The available treatments are:

Medications

These are given for months or even for years. Two most common medications given are:

• Antithyroid drugs: These reduce the production of thyroid hormone by inhibiting the use of iodine by the thyroid. The main types used are methimazole (tapazole) and propylthiouracil. These are not used to treat hyperthyroidism caused by thyroiditis.

• Beta blockers: Beta blockers have no effect on the level of thyroid hormone. These control the hyperthyroidism symptoms such as tremors, rapid heart rate. Examples of beta blockers include propranolol, atenolol.

Radioactive therapy

Radioactive iodine is a very common treatment for hyperthyroidism. Radioactive iodine is given as a liquid or a capsule. A single dose is all that is needed. It is taken into thyroid cells where it slowly destroys them and eventually the thyroid gland produces less thyroid hormone. Once the thyroid is destroyed, there will be a drop in thyroid hormones. Most people will develop hypothyroidism. Therefore, the patient will need to stay on thyroid hormone replacement system throughout life. It is not recommended in pregnant and breastfeeding or those planning to become pregnant.

Surgery

In severe cases, a surgery called thyroidectomy is performed to remove all or part of the thyroid gland. Before surgery, you will be asked to take antithyroid medicine to bring the thyroid hormone in normal range. After surgery, the patient will need to be maintained on thyroid replacement therapy for the rest of their life. Complications of surgery include damage to the parathyroid glands, injury to the nerves or an infection.

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