Hyperthyroidism

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What is hyperthyroidism?

Hyperthyroidism is a condition where the thyroid gland produces an excessive amount of thyroid hormones, which disturbs the body’s metabolism.

Alternate names

  • Overactive thyroid
  • Hyperthyreosis

Is hyperthyroidism a medical emergency?

Hyperthyroidism is not a medical emergency.

Causes of hyperthyroidism

The following are some of the common causes:

  • Graves’ disease: An autoimmune disorder that stimulates the thyroid to produce too much thyroxine (T4) hormone
  • Thyroiditis: Infection and inflammation of the thyroid gland
  • Plummer disease: A condition that causes thyroid gland enlargement and overproduction of thyroid hormone
  • Excess iodine intake
  • Tumors of ovaries or testes
  • Tumors of thyroid or pituitary gland
  • Excess intake of thyroid hormone tablets
  • Certain medications like amiodarone, an antiarrhythmic drug, can cause overactivity of the thyroid gland

Risk factors for hyperthyroidism

  • Having a family history of thyroid disease or Graves’ disease
  • Female gender
  • Having medical conditions like diabetes, pernicious anemia, and primary adrenal insufficiency

Signs & symptoms of hyperthyroidism

Signs and symptoms of hyperthyroidism include the following:

  • Fast, irregular heartbeat
  • Unintentional weight loss
  • Increased appetite
  • Irritability
  • Anxiety
  • Nervousness
  • Tremors
  • Sweating
  • Heat intolerance
  • Fatigue and muscle weakness
  • Difficulty sleeping
  • Inability to concentrate
  • Enlarged thyroid gland
  • Diarrhea
  • Fine, brittle hair

Investigations

Investigation tests that are performed to check for hyperthyroidism include:

  • Blood tests: To measure thyroxine and thyroid-stimulating hormone (TSH).
  • Radioiodine uptake test: This test measures how much iodine is absorbed by the thyroid gland.
  • Thyroid scan: A thyroid scan is performed to evaluate thyroid function.
  • Thyroid ultrasound: Ultrasound is performed to capture the images of the thyroid gland and to rule out any nodules or other abnormalities.

Diagnosis

A complete medical and physical examination is performed to detect any tremors, reflexes, eye changes, warm and moist skin, pulse, irregular heartbeat, and thyroid enlargement. The diagnosis of hyperthyroidism is made depending upon the findings of physical examination and the results of the investigation test.

Hyperthyroidism treatment options

Treatment for hyperthyroidism depends upon the age of the individual, physical condition, and the underlying cause of the disease.

A. Medical treatment

Medical treatment for hyperthyroidism includes:

  • Anti-thyroid medications: These medications include methimazole, carbimazole, and propylthiouracil.
  • Beta-blockers: These medications are used to treat high blood pressure and reduce symptoms like tremors, rapid heart rate, and palpitations.

B. Interventional treatment including surgery and indications for surgery/surgical treatment

Surgical treatment for hyperthyroidism includes:

  • Thyroidectomy: A part of the thyroid gland is removed. This surgery is recommended when an individual cannot tolerate anti-thyroid drugs nor radioactive iodine therapy. Throughout life, levothyroxine is taken orally to replace the required amount of thyroid hormone.

C. Radiation

  • Radioactive iodine: Radioactive iodine is given orally and absorbed by the thyroid gland. This decreases thyroid function. Levothyroxine is taken orally to replace the required amount of thyroid hormone.

D. Role of diet/exercise/lifestyle changes/preventive measures

Lifestyle modifications for hyperthyroidism include:

  • Consuming a diet rich in calcium, sodium, and vitamin D
  • Reducing eating excessive amounts of iodine-rich foods like iodized salt, fish, dairy products, etc.
  • Regular exercise

Complications of hyperthyroidism

This can lead to complications such as:

  • Heart disorders: Hyperthyroidism can lead to heart problems such as rapid heart rate, irregular rhythm, atrial fibrillation, and congestive heart failure.
  • Bone disorders: Hyperthyroidism can cause weak and brittle bones.
  • Eye problems: Hyperthyroidism can cause eye problems like bulging, red and swollen eyes with vision impairments.
  • Skin disorders: In rare cases, individuals with Graves’ disease can develop skin disorders.
  • Thyroid storm: This is a rare complication in which an individual develops a fever, rapid pulse, confusion, and often death.

Prognosis

The prognosis depends upon the cause of the condition. In the majority of cases, hyperthyroidism is treatable, however, hyperthyroidism due to Graves’ disease, results in serious complications, and a poor prognosis.

When to contact the doctor or hospital/how to identify the emergency or complications?

Hyperthyroidism when associated with symptoms like shortness of breath, fast and irregular heartbeat, and dizziness, requires immediate medical attention.

Indications for hospitalization if required

Hospitalization is warranted after noticing any complications such as rapid heart rate, abnormal heart rhythm, or heart failure. Extreme symptoms of hyperthyroidism called thyroid storm cause dangerously high levels of pulse, blood pressure, and temperature requiring hospitalization.

Suggested clinical specialists/departments to consult for this condition

  • Endocrinology
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