Hyperthyroidism

Causes Of Hyperthyroidism

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 the food into energy which helps the body function)

• Breathing

• Heart rate

• Body temperature

Normally, the body is supposed to produce the right amount of TSH and thyroxine that can regulate normal functioning in a person. But 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 is present when the disorder lies within the thyroid gland, leading it to produce large amounts of thyroxine. This can be caused due to different conditions such as:

Graves' disease: Graves’ disease, the most common cause of hyperthyroidism, is an autoimmune condition in which the immune system overproduces an antibody called thyroid-stimulating immunoglobulin (TSI). This antibody starts attacking the thyroid gland, which stimulates the thyroid to make excessive thyroid hormone. The exact cause behind Graves' disease is unknown. 

Graves' disease is a genetic condition and can pass down in a family. Women are more likely to suffer from Grave's disease than men. It typically presents in people 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 produce more than the required hormone that leads to hyperthyroidism. Overactive thyroid nodules are usually large (an inch or more in size) and can be big enough to be felt in the neck. Mostly, these nodules are non-cancerous. 

Thyroiditis: The swelling or inflammation of the thyroid gland is called thyroiditis. When the thyroid gland swells, it starts leaking excessive hormones that lead to a higher level of thyroid hormones than needed. As a result, one may develop symptoms of hyperthyroidism. Thyroiditis can occur due to infections, an immune system disorder or after the delivery of a baby, known as postpartum thyroiditis. 

Hyperthyroidism from thyroiditis usually lasts for a few months. The thyroid usually recovers on its own, but sometimes, it gets damaged. This can lead to hypothyroidism or underactive thyroid.

Iodine: Iodine is a mineral that is used by the thyroid gland to produce thyroid hormones. Consuming too much iodine through diet like seaweed and seaweed-based supplements and medications like some cough syrups or heart medicine amiodarone can result in high thyroid hormone. Rarely, iodine dye or intravenous iodinated contrast used for x-ray based imaging tests can also cause hyperthyroidism. 

2. Secondary hyperthyroidism

This condition is rare and arises due to increased stimulation of the thyroid gland by excessive TSH in the circulation. This can be caused due to a non cancerous pituitary tumour that overproduces TSH. The hypothalamus produces thyroid releasing hormone (TRH) that stimulates TSH. Rarely, the overproduction of TRH from the hypothalamus can cause an increase in the levels of TSH. 

3. Subclinical hyperthyroidism

Subclinical hyperthyroidism causes low or undetectable levels of TSH with a normal level of thyroid hormones. It can be caused due to medical disorders such as Graves' disease, multinodular toxic goitre (enlarged thyroid gland), and thyroiditis. Medications such as glucocorticoids, amiodarone, and dopaminergic drugs can also cause subclinical hyperthyroidism. 

4. Hyperthyroidism in neonates

This is a rare condition seen 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. 

Sometimes, it is also seen in newborn babies of mothers with a normal thyroid gland function (euthyroid). An increase in maternal TSH-receptor antibodies can cause hyperthyroidism in neonates.  

Symptoms Of 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 towards 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 people. 

Risk Factors For Hyperthyroidism

You may be at a higher risk of developing hyperthyroidism, if you:

• Have a family history of thyroid disorders

• Had thyroid surgery or a thyroid problem such as a goitre (swollen thyroid gland)

• Are a women

• 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)

Diagnosis Of Hyperthyroidism

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 will help them 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. This suggests that the thyroid gland is making the excessive hormone that has caused the pituitary to stop releasing TSH into the blood. If the TSH levels are not normal, your physician might recommend an additional test 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 can’t get into body cells. Only about 1%–2% of T4 in the blood is unattached (“free”) and can get into cells. The free T4 and the free T4 index are both simple blood tests that measure how much unattached T4 is in the blood and available to get into 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. Triiodothyronine (T3) total test measures the total levels (both free and bound forms) of triiodothyronine (T3) hormone in the blood and is usually done as a part of the thyroid profile total test. Hyperthyroid patients typically have an elevated level 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: Thyroid scan can help to evaluate the size, shape, and position of the thyroid gland. This test uses a small amount of radioactive iodine to help diagnose the cause of hyperthyroidism and check for thyroid nodules as well.

Ultrasound: Ultrasound of the thyroid is used to closely look at thyroid nodules. Thyroid nodules are solid or fluid-filled lumps that form within the thyroid gland. Ultrasound can also help the doctor to evaluate if the nodules are cancerous in nature.

Radioactive iodine uptake test: A radioactive iodine uptake test, also called a thyroid uptake test, measures how much radioactive iodine the thyroid takes up from the blood after swallowing a small amount of it. It can help check thyroid function and find the cause of hyperthyroidism. 

Prevention 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, and avoiding smoking. 

Specialist To Visit

You should visit a doctor, if you are experiencing symptoms such as unexplained weight loss, increased appetite, intolerance to heat, excessive sweating, brittle hair, nervousness, tremors, and heart palpitations. These symptoms might indicate the possibility of hyperthyroidism. You can consult the following doctors for a diagnosis:

• General physician 

• Endocrinologist

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Treatment Of Hyperthyroidism

Hyperthyroidism can be managed through several kinds of treatment modalities. The best approach is decided on an individuals age, overall wellbeing, underlying cause, and severity of the disorder. The treatments include:

1. 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 through their mouth. It acts solely on the thyroid gland and slowly destroys the thyroid gland cells that are producing thyroid hormone. 

However, people on radioiodine therapy end up developing 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 shouldn't take radioactive iodine as it can affect the baby's thyroid glands. Occasionally a person can lose sensation in their mouth after the therapy. The sensation loss may last for up to a year but returns to normal later. 

2. Antithyroid medications

Antithyroid drugs are the easiest way to manage hyperthyroidism. Doctors most often recommend methimazole. Pregnant women are recommended propylthiouracil during the first three months as rarely, methimazole can harm the developing baby. 

Antithyroid drugs cause the thyroid gland to produce less hormone. A patient on antithyroid medicine can expect an average treatment time of 1-2 years. In some cases, one might need to take the medicines for several years. This is the simplest treatment, but it is often not a permanent cure. These medications can temporarily ease the symptoms of patients with Graves' disease. However, they are not used for hyperthyroidism caused by thyroiditis. 

Antithyroid drugs can cause side effects such as allergic reactions, reduction in the body's white blood cells, and rarely, liver failure. 

3. Beta-blockers

These drugs block the effect of thyroid hormones on the body. However, it does not stop the production of hormones. They are not used alone but as an adjunct to another option to treat hyperthyroidism over the long term.

Beta blockers act by widening or relaxing the blood vessels. They can reduce symptoms like tremors, rapid heartbeat, and nervousness until other treatments start working.

A patient can feel improvement in their symptoms within hours of these medications. 

4. Thyroid surgery

With the introduction of radioactive iodine therapy and antithyroid drugs, surgery for hyperthyroidism (thyroidectomy) has become less common. This surgery entails the removal of a part or most of the thyroid gland. Doctors recommend this surgery in:

• Pregnant women and children who are at risk of developing side effects from antithyroid medications.

• People with very large thyroid glands facing issues such as difficulty swallowing, hoarseness, and shortness of breath.

Removing a part of the thyroid gland may cause hypothyroidism after the surgery. This would require the patient to take thyroid hormone for the rest of their lives to maintain their hormone levels. 

In rare cases, a patient might face complications such as paralysis of vocal cords and damage to parathyroid glands that produce calcium. Accidental removal of parathyroid glands may result in low calcium levels and require calcium replacement therapy.

5. Radiofrequency ablation (RFA)

This is a new approach to treat thyroid nodules that results in tissue necrosis and shrinkage of nodules. It's a minimally invasive treatment for benign (non-cancerous) thyroid nodules. RFA is primarily recommended for people who have not benefited from medications or surgery. 

Home-care For Hyperthyroidism

If you have been prescribed antithyroid medications, take the medications on time regularly. The amount of time it takes to treat hyperthyroidism depends on the cause of the disorder. With antithyroid drugs, a person's hormone levels should drop to a manageable level within 6 to 12 weeks. 

After that, your doctor might prescribe the patient with high doses of non-radioactive iodine drops that will normalise thyroid levels within seven to ten days. To avoid forgetting your medications, you can put them into labelled containers and set alarms that remind you about them. 

If you have undergone thyroid surgery, then closely follow the post operation instructions given by your doctor to avoid infections. Make sure to take the prescribed thyroid hormone drugs that will help you maintain your thyroid levels. 

Diet 

Consuming a wholesome and balanced meal with plenty of vegetables, fruits, and lean protein sources is an important way of ensuring that you are getting the necessary nutrients. If you have lost a lot of weight due to hyperthyroidism, your doctor will put you on a diet that helps in healthy weight gain. A low-iodine diet is often recommended to people with hyperthyroidism since excessive iodine aggravates T4 production. 

You should avoid eating foods with high iodine content such as saltwater fish, cheese, milk, eggs, kelp, or seaweed. If you are taking any supplements, then make sure that it doesn't contain iodine. Sodium can also contribute to swelling, which is common with Graves’ disease, so salt intake needs to be kept in check as well. Untreated hyperthyroidism can weaken the bone structure. To counteract that, eat food items rich in calcium such as tofu, fortified soy or calcium supplements. 

Exercise

Regular exercise is good for your long term health and especially for people with hyperthyroidism. Mild cardiovascular exercises can relieve stress and reduce nervousness &  irritability caused by hyperthyroidism. Strength training also helps in increasing bone density. However, it is important to not overdo any exercise since the heart rate and metabolic rate are already elevated at rest, in cases of untreated hyperthyroidism. 

You can start with low-intensity workouts such as walking, yoga, and tai chi. Seeking out professional trainers who have experience working with patients having medical conditions can also prove helpful. Exercising can help a patient after a thyroid surgery by preventing excess weight gain and controlling their appetite. 

Stress management

Hyperthyroidism increases anxiety and nervousness. Stress can aggravate hyperthyroid symptoms and make them worse. Stress management is an important part of treating hyperthyroidism, especially in patients with Graves' disease. Implementing relaxation techniques like meditating for a few minutes every day is a good way to start. Going for a walk outside to get in some fresh air can have a calming effect. 

Nutritional supplements

People with hyperthyroidism can have supplements such as Vitamin D, multivitamins without iodine, probiotics, omega-3 fatty acids, Vitamin C, and L-carnitine. It is important to consult your doctor before adding any supplements to your diet. 

Complications Of Hyperthyroidism

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

1. Heart diseases

Hyperthyroidism causes rapid or irregular heartbeat. A rapid heartbeat is caused as a result of fast metabolism caused by hyperthyroidism. The body runs faster than normal with an overactive thyroid and hence causes the sensation of a racing heart. This increases your risk of facing medical conditions such as stroke and heart failure. 

2. Bone disorders

Unchecked levels of thyroid hormones can cause weakening of the skeletal system and make your bones brittle. Excessive thyroxine affects the rate of bone replacement and speeds up the pace of bone loss. The bone producing cells (osteoblasts) are unable to replace the lost bone at the required rate. This can result in osteoporosis, a condition that causes bones to become weak and fracture. 

3. Eye and skin problems

Hyperthyroidism caused due to Graves' disease affects both the eyes and the skin. It can affect your eyes in several ways 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. It specifically affects the feet and shin. 

4. Thyrotoxic crisis (thyroid storm)

A thyroid storm is a serious complication of hyperthyroidism. It occurs due to a sudden and severe elevation in thyroid hormone levels. This is a life-threatening condition that needs immediate medical attention. The most common symptom of a thyroid storm is increased body temperature, blood pressure, heart rate, and a sudden change in mental state like confusion or lethargy. 

5. Infertility and complications during pregnancy

Hyperthyroidism can cause a marked reduction in the sperm count of men, which affects their fertility. The count goes back to normal once the thyroid disorder has been treated. Women with untreated Graves' disease may have lighter or irregular periods and face difficulty in conceiving. Hyperthyroidism may also increase the risk of early-term miscarriage and premature birth. 

Alternative Therapies For Hyperthyroidism 

Homoeopathic drugs like lodium, natrum muriaticum, and lachesis mutus have shown effectiveness in managing hyperthyroidism. 

Living With 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 cause behind 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 happy with the quick weight loss, but that's not healthy. Consult your doctor to learn the healthy weight for you and consume enough calories to help you maintain that. 

2. Consume the right diet
Having a balanced meal can work wonders for patients with Graves' disease. If you have faced excessive weight loss due to hyperthyroidism, increasing your food intake can overtake the increase in metabolic rate and help you gain weight. 

Hyperthyroidism also leads to an increased appetite. It is important to have healthy snacks in between your meals to satiate your hunger the healthy way. Patients with hyperthyroidism should avoid having excessive sugar since the condition speeds up the rate of insulin metabolism. This increases the rate of production and absorption of glucose. This can result in insulin resistance, especially for diabetic patients. 

3. Avoid smoking and secondhand smoke
Graves' eye disease can develop in patients who have Graves' disease. Smoke can worsen this eye disease, so it is essential not to smoke and to avoid secondhand smoke.

4. Practice yoga and meditation 
Hyperthyroidism is notorious for its effects on mental health such as anxiety and nervousness. Additional stress from everyday situations can aggravate your thyroid symptoms. To counter that, patients with hyperthyroidism should regularly take some time off 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 stay consistent throughout the day, taking the medicines at evenly spaced intervals is important. Antithyroid medications take some time to work, so it is important to follow the prescribed medication cycle.