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Hyperthyroidism

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hyperthyroidism overview diagnosis treatment American Thyroid Association

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https://www.thyroid.org/graves-disease

Hyperthyroidism

Hyperthyroidism means the thyroid gland is producing excessive thyroid hormone. This speeds up many body processes.

Common causes

  • Graves disease: autoimmune stimulation of the thyroid, and the commonest endogenous cause. It can cause eye prominence or irritation and, less often, thickened skin over the shins. - Robbins, Cotran & Kumar Pathologic Basis of Disease, p. 1000
  • Toxic multinodular goiter or a toxic adenoma
  • Thyroiditis: temporary release of preformed thyroid hormone, sometimes painful and sometimes postpartum
  • Iodine-containing medicines or contrast, especially amiodarone
  • Excess prescribed or ingested thyroid hormone. - The Washington Manual of Medical Therapeutics, p. 919

Symptoms and signs

Typical features include:
  • Palpitations, fast heartbeat, tremor
  • Heat intolerance and sweating
  • Weight loss despite normal or increased appetite
  • Anxiety, irritability, insomnia
  • Tiredness and proximal muscle weakness
  • Frequent stools
  • Light or irregular periods
  • Goiter
Older adults may have fewer obvious symptoms and present with atrial fibrillation, heart failure, weakness, or unexplained weight loss. - The Washington Manual of Medical Therapeutics, p. 920

Diagnosis

Blood tests usually show:
  • Low/suppressed TSH
  • High free T4 and/or T3
The clinician then identifies the cause using thyroid-receptor antibodies for suspected Graves disease, and sometimes thyroid ultrasound with Doppler or a radioactive iodine uptake scan. A normal TSH makes overt clinical hyperthyroidism unlikely. - The Washington Manual of Medical Therapeutics, p. 920

Treatment

Treatment depends on cause, severity, age, pregnancy status, heart disease, and eye disease.
  1. Beta-blocker for rapid relief of tremor, palpitations, and fast heart rate, if safe for the person.
  2. Antithyroid medication, most often methimazole. PTU is generally reserved for selected situations, including the first trimester of pregnancy.
  3. Radioactive iodine to permanently reduce thyroid activity. It is not used in pregnancy.
  4. Thyroidectomy in selected cases, such as large goiter, suspicion of cancer, some cases with significant eye disease, or preference for definitive treatment.
For Graves disease, American Thyroid Association guidance describes beta-blockade plus antithyroid drugs, radioactive iodine, or surgery as the main approaches. Treatment should be prescribed and monitored by a clinician because antithyroid medicines can rarely cause serious adverse effects, including dangerously low white blood cells or liver injury.

Seek urgent care now for

High fever, severe agitation or confusion, vomiting/diarrhea, chest pain, shortness of breath, fainting, or a very rapid/irregular heartbeat. These can signal thyroid storm or a major cardiac complication.
If you have symptoms or an abnormal thyroid test, arrange medical review promptly for TSH, free T4, and usually T3 testing.
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