OVERACTIVE THYROID (HYPERTHYROIDISM)

Hyperthyroidism, commonly known as an overactive thyroid, is a condition where the thyroid gland produces an excessive amount of thyroid hormones.

Hyperthyroidism occurs when your thyroid gland, situated at the base of your neck, produces an excess of thyroid hormone, disrupting the balance needed for your body to function properly. This condition manifests in various ways, affecting your hair, eyesight, heart rate, mood, and weight.

Addressing an overactive thyroid typically requires medical intervention, such as medication or surgery, as it usually cannot correct itself.

Difference between hyperthyroidism and hypothyroidism

It’s essential to differentiate between hyperthyroidism and hypothyroidism, despite their similar-sounding names. While hyperthyroidism involves an overproduction of thyroid hormone, hypothyroidism occurs when the thyroid gland doesn’t produce enough hormones. These conditions present different symptoms and necessitate distinct treatment approaches.

Function of the Thyroid

Thyroid hormone consists of two key hormones: thyroxine (T-4) and triiodothyronine (T-3). These hormones play crucial roles in regulating various bodily functions. For example, they influence heart rate, digestion speed, metabolism, and the health of your central nervous system, skin, and hair. Essentially, thyroid hormone impacts nearly every cell in your body, dictating how your body operates.

Causes of overactive thyroid (Hyperthyroidism)

Hyperthyroidism stems from various health issues, including:

Graves’ Disease: This autoimmune condition is the primary cause of hyperthyroidism. In Graves’ disease, the immune system mistakenly targets the thyroid gland, prompting it to produce excessive thyroid hormone. The exact reason why some individuals develop Graves’ disease remains unclear, but it often runs in families and is more prevalent among individuals assigned female at birth (AFAB) under the age of 40.
Thyroid Nodules (Plummer’s Disease): These abnormal growths within the thyroid can become overactive, leading to an excess production of thyroid hormone. Plummer’s disease is more commonly observed in older individuals.
Thyroiditis: Inflammation of the thyroid gland can cause it to release hormones into the bloodstream excessively. Thyroiditis may precede hypothyroidism, wherein the thyroid produces insufficient hormones. Thyroiditis can occur after pregnancy, due to viral infections, immune system issues, or excessive intake of thyroid medication.
Iodine Overload: Excessive intake of iodine, often through medications or supplements, can result in hyperthyroidism. The thyroid utilizes iodine to produce thyroid hormone.

Additionally, about 30% of individuals with Graves’ disease develop thyroid eye disease (TED), which impacts vision and the structure of the eyes. TED symptoms include bulging eyes, eye discomfort, pain, pressure, redness, inflammation, puffy or retracted eyelids, light sensitivity, double vision, and vision loss. It’s important to monitor changes in vision and seek medical attention if necessary, even without a diagnosis of Graves’ disease.

Prevalence

Hyperthyroidism affects approximately 1.2% of the population in the United States, with women being more commonly affected than men. The condition can occur at any age but is more prevalent in individuals over the age of 60.

Symptoms of overactive thyroid (Hyperthyroidism)

Hyperthyroidism accelerates your metabolism, leading to a range of discomforting symptoms. These commonly include:

Feeling Nervous or Anxious: A heightened sense of nervousness or anxiety.
Mood Swings: Experiencing frequent changes in mood.
Energy Fluctuations: Having either more or less energy than usual.
Trouble Swallowing: Difficulty in swallowing.
Goiter: Swelling of the thyroid gland, visible as swelling at the base of the neck.
Sudden Weight Loss: Losing weight unexpectedly, without intentional efforts.
Irregular Heartbeat: Fast, uneven heartbeat or palpitations.
Increased Bowel Movements: Experiencing more frequent bowel movements.
Heightened Hunger: Feeling an increase in appetite.
Excessive Sweating: Noticing increased sweating.
Muscle Weakness: Feeling weak in the muscles.
Hand Tremors: Shaking in the hands and fingers.
Insomnia: Difficulty falling or staying asleep.
Thinning Skin: Skin becoming thinner.
Hair Changes: Experiencing hair breakage or loss.
Menstrual Changes: Changes in menstrual patterns, such as lighter periods or less frequent menstruation.
Eye Pain: Experiencing pain in the eyes.

Initially, you might feel energetic due to the accelerated metabolism. However, prolonged hyperthyroidism can exhaust your body, leading to fatigue.

Older adults may exhibit subtler symptoms, such as a faster heart rate or increased sensitivity to warm temperatures.

It’s essential to note that certain medications, like beta-blockers used to treat high blood pressure or other conditions, can mask the signs of hyperthyroidism. Inform your doctor about all medications you’re taking to ensure accurate diagnosis and treatment.

Risk Factors of overactive thyroid (Hyperthyroidism)

Certain factors increase the risk of developing hyperthyroidism:

Being assigned female at birth (AFAB)
Age between 40 and 60 years
Family history of hyperthyroidism
High iodine intake from diet or supplements
Pregnancy
Stress

Moreover, specific ongoing health conditions can elevate the risk, including type 1 diabetes, Addison’s disease, and pernicious anemia. If you have any of these risk factors or experience symptoms of hyperthyroidism, it’s crucial to consult with a healthcare professional for proper evaluation and management.

Diagnosis of overactive thyroid (Hyperthyroidism)

Diagnosing hyperthyroidism typically involves a thorough evaluation of your medical history and a physical examination to identify symptoms such as a swollen thyroid, rapid pulse, moist skin, and tremors in your hands or fingers. Your doctor may recommend the following tests:

Thyroid Panel: This blood test measures levels of thyroid hormone and thyroid-stimulating hormone (TSH).
Thyroid Scan: A small amount of radioactive iodine is injected into your bloodstream, which is absorbed by the thyroid gland. Special imaging techniques, such as a camera, are then used to examine the gland for nodules or abnormalities.
Ultrasound: Using sound waves, a transducer creates images of the thyroid gland.
Radioactive Iodine Uptake Test: You consume a safe, minimal amount of radioactive iodine, and a gamma probe measures the uptake of iodine by the thyroid gland. Elevated uptake suggests conditions such as Graves’ disease or thyroid nodules.

Treatments for overactive thyroid (Hyperthyroidism)

Treating hyperthyroidism involves reducing the levels of thyroid hormone in your body. Your doctor will consider factors such as your age, overall health, the underlying cause of your condition, and your specific symptoms to determine the most appropriate treatment option for you. Here are the common treatment options:

Radioactive Iodine: This method is frequently used to address hyperthyroidism. You consume a small, safe dose of radioactive iodine, which is absorbed by the overactive thyroid cells. This causes these cells to die off, leading to a reduction in thyroid size and hormone levels. However, it may take several months for symptoms to improve. While this treatment may result in hypothyroidism, it’s relatively manageable with hormone supplements taken daily.
Surgery (Thyroidectomy): In cases where medications are not suitable, your doctor may recommend removing part or all of your thyroid gland. Following surgery, you’ll need to take a daily hormone pill to maintain the necessary levels of thyroid hormone in your body. However, this procedure carries risks, including potential damage to the vocal cords and parathyroid glands, which regulate blood calcium levels.
Anti-Thyroid Drugs: These medications work by preventing the thyroid gland from producing excessive hormones. Symptom improvement may be observed within a few months, but treatment typically continues for at least a year. Anti-thyroid drugs are a safe option, particularly for pregnant or nursing individuals, or those planning pregnancy.
Beta-Blockers: Although primarily used to manage high blood pressure, beta-blockers can alleviate symptoms associated with high levels of thyroid hormone. While they don’t directly lower thyroid hormone levels, they can help alleviate symptoms such as anxiety, tremors, and rapid heartbeat.

Home Care Tips

Maintain a Balanced Diet: Ensure adequate intake of nutrients, especially iodine, while avoiding excessive iodine consumption.
Manage Stress: Practice stress-reduction techniques such as meditation, deep breathing exercises, or yoga to help manage symptoms.
Monitor Symptoms: Keep track of symptoms and report any changes to your healthcare provider promptly.
Stay Hydrated: Drink plenty of water to stay hydrated, especially if experiencing increased sweating.

Diet for hyperthyroidism

Maintaining a healthy diet is essential for managing hyperthyroidism and promoting overall well-being. Here are some dietary guidelines to consider:

Foods to Eat:

Include a variety of fruits, vegetables, and whole grains in your diet to ensure a balanced intake of vitamins, minerals, and fiber.
Incorporate sources of lean protein such as poultry, fish, beans, lentils, and tofu.
Consume healthy fats from sources like olive oil, avocados, and nuts.
Opt for seeds, nuts, and legumes like peanuts and lentils for additional nutrients and protein.

Foods to Limit:

Avoid processed foods high in sugar and unhealthy fats, such as candy and chips, as they provide little nutritional value.
Limit foods high in iodine, as excessive iodine intake can exacerbate hyperthyroidism. These may include iodized salt, dairy products, egg yolks, cheese, sushi, seaweed, lobster, crabs, and prawns.

Consult with a Dietitian:

Talking to a dietitian can provide personalized guidance on navigating dietary restrictions and making healthy food choices that support thyroid health.
A dietitian can help you understand which foods to avoid and suggest suitable alternatives to ensure optimal nutrition while managing hyperthyroidism.

Weight Management:

Weight gain may occur after starting treatment for hyperthyroidism, as your body adjusts to normalized thyroid hormone levels.
If concerned about weight management, consult with your doctor or a nutritionist for personalized advice and meal planning strategies to maintain a healthy weight.

Complications of Untreated hyperthyroidism

Untreated hyperthyroidism can lead to various complications, including:

Skin Rashes: Excessive thyroid hormone levels may cause skin issues such as rashes.
Muscle Weakness: Hyperthyroidism can result in muscle weakness, affecting physical strength and coordination.
Heart Issues: Long-term overactivity of the thyroid gland can strain the heart, potentially leading to heart failure.
Blood Clots: Hyperthyroidism increases the risk of blood clot formation, which can potentially lead to serious complications such as pulmonary embolism or stroke.
Difficulty Getting Pregnant: Imbalances in thyroid hormone levels can interfere with reproductive health and make conception challenging.
Osteoporosis: Chronic hyperthyroidism can weaken bones, increasing the risk of osteoporosis and fractures.
Stroke: Elevated thyroid hormone levels may contribute to cardiovascular issues, increasing the risk of stroke.

In severe cases, untreated hyperthyroidism can lead to a life-threatening condition known as thyrotoxic crisis or thyroid storm. Symptoms of a thyroid storm include:

High Fever: A temperature of 104°F or higher.
Rapid Heart Rate: A heart rate exceeding 140 beats per minute.
Delirium: Confusion or disorientation, difficulty understanding surroundings.

Prevention of overactive thyroid (Hyperthyroidism)

Since hyperthyroidism cannot be prevented, awareness of risk factors can facilitate early detection and treatment. This proactive approach enables individuals and healthcare providers to monitor health closely and promptly initiate treatment if symptoms emerge.

For those experiencing thyroid eye disease with mild symptoms, management strategies include:

Avoiding Bright Lights: Shielding the eyes from bright lights can help alleviate discomfort.
Protecting Eyes in Windy Weather: Wearing protective eyewear in windy conditions can prevent further irritation.
Elevating the Head of the Bed: Raising the head of the bed during sleep can reduce swelling around the eyes.
Using Eye Drops: Eye drops may provide relief from dryness or irritation.
Selenium Supplement: Some evidence suggests that selenium supplementation may improve thyroid function, although further research is needed to confirm its effectiveness.

In cases where symptoms of thyroid eye disease are severe, treatment options may include:

Teprotumumab-trbw (Tepezza): This medication, approved by the FDA, targets symptoms of thyroid eye disease.
Steroids or Other Medications: These may be prescribed to manage swelling behind the eyes.

In severe cases, surgical intervention may be necessary:

Orbital Decompression Surgery: This procedure involves removing bone between the sinuses and eye socket to create more space for the eyes, potentially improving vision. Risks include double vision.
Eye Muscle Surgery: Used to correct double vision, this surgery involves repositioning eye muscles affected by scar tissue due to thyroid eye disease. Multiple surgeries may be required for optimal outcomes.

Individuals with thyroid eye disease should work closely with their healthcare providers to determine the most appropriate management approach based on the severity of symptoms and individual health considerations. Regular monitoring and timely intervention can help mitigate the impact of thyroid eye disease on vision and overall well-being.

Pregnancy and Hyperthyroidism

Hyperthyroidism can pose challenges for individuals trying to conceive and during pregnancy, affecting both maternal and fetal health. Excess thyroid hormone levels can make conception difficult and lead to complications during pregnancy.

In some cases, hyperthyroidism may result from severe morning sickness, presenting as a temporary condition.

When hyperthyroidism occurs during pregnancy, management approaches may vary depending on the severity of symptoms and thyroid hormone levels. If symptoms are mild and thyroid hormone levels are only slightly elevated, your doctor may opt for close monitoring through monthly blood tests without immediate treatment. However, if thyroid hormone levels become a concern, initiating low-dose anti-thyroid medication is often recommended.

For individuals allergic to anti-thyroid medication or unable to tolerate it, surgical removal of part or all of the thyroid gland may be considered. This option is typically safest during the second trimester of pregnancy, minimizing potential risks to both the mother and the developing fetus.

When to See a Doctor

If you experience symptoms such as unexplained weight loss, rapid heartbeat, excessive sweating, or anxiety, it is essential to consult a healthcare professional for evaluation and diagnosis. Prompt treatment can help alleviate symptoms and prevent complications associated with hyperthyroidism.

Outlook/Prognosis

With appropriate treatment and management, the prognosis for individuals with hyperthyroidism is generally favorable. However, untreated hyperthyroidism can lead to serious complications, including heart problems, osteoporosis, and thyroid storm, a life-threatening condition characterized by severe symptoms of hyperthyroidism. Regular follow-up appointments with a healthcare provider are essential to monitor thyroid function and adjust treatment as needed.

Sources

American Thyroid Association. (n.d.). Hyperthyroidism (Overactive). R
Mayo Clinic. (2022). Hyperthyroidism (Overactive Thyroid).
National Institute of Diabetes and Digestive and Kidney Diseases. (2021). Hyperthyroidism (Overactive Thyroid).
Cleveland Clinic. (2023). Hyperthyroidism (Overactive Thyroid).
American Association of Clinical Endocrinology. (2020).
MedlinePlus. (2023). Hyperthyroidism. R
The Hormone Health Network. (n.d.). Hyperthyroidism.
UpToDate. (2022). Patient education: Hyperthyroidism (overactive thyroid) (Beyond the Basics).

HYPERTHYROIDISM OVERACTIVE THYROID