How to Recognize and Treat Hyperthyroidism?

Over active thyroid gland results in hyperthyroidism. This condition is characterized by the production of excess of thyroid hormones.

Recognizing Hyperthyroidism

Though the symptoms mimic other conditions encountered in  day to day life, a careful observation followed by investigations may reveal the condition.

Common Symptoms

• Loss of body weight, even though the diet is adequate
• Nervousness, accompanied by sweating. The palms and sole appear wet due to sweat.
• Irritability, mood changes
• Pounding heart. The heart rhythms may get disturbed, irregular or too fast
• Slight tremors in hands may be seen
• Menstrual disturbances
• Digestive problems
• Fatigue
• Thinning of skin, brittle hair
• Swelling in the neck, due to enlargement of the gland

Causes of Excess Thyroid Hormone Production

Graves Disease

This is an autoimmune disorder where antibodies are produced against the thyroid tissues. This stimulates the gland to produce more of active thyroid hormone.

Typically, the antibodies produced cause swelling just behind the eyeballs, leading to protrusion or bulging of eyes. This is a characteristic sign of the condition.

Toxic Multinodular Goiter and Plummer’s Disease

An adenoma is a part of thyroid tissue that walls off itself from the rest of the gland and produces hormones. Though this is not cancerous, adenomas are independent and don’t obey the feed back mechanism provided in the body for the regulation of hormone production.

In plummer’s disease, many such adenomas get formed in the thyroid gland.

Thyroiditis

Inflammation of the thyroid tissue may be acute or chronic. It is sometimes painful, and the patient complains of pain in the neck region.

In few of these conditions, the gland gets stimulated to produce excess of thyroid hormones.

The above mentioned conditions have been seen to run in families, especially graves disease. This indicates some genetic link of the condition.

Investigating Hyperthyroidism

Initial screening is done usually on the basis of symptoms. The patient may present with menstrual irregularities. Doctor needs to look for signs like bulging eyes, moist skin, tremors when both hands are extended.

The first test to be done is blood work, where the levels of TSH and active hormone thyroxine is measured in blood.

The condition is characterized by high levels of thyroxine and low or negligible levels of TSH.

Further Tests

Radioactive Thyroid Uptake Test

Radioactive iodine is taken by mouth. This is absorbed by the thyroid gland. This is because iodine is required by the gland to produce hormones.

Scans are then taken to assess absorption. Excess iodine is seen to be absorbed in graves disorder and adenomas. In thyroiditis, iodine absorption is not much.

Thyroid Scan

Iodine isotope is injected in a vein of the forearm. This reaches the thyroid tissue and the gland is scanned to assess activity.

Untreated Hyperthyroidism

This may lead to further complication.

They include:

Heart problems: The rhythms of the heart are affected by too much of circulating thyroid hormone. The beats may become too fast or irregular. The patient may present from what is called atrial fibrillation, congestive heart failure, where the heart fails to pump blood.

Osteoporsis: The hormone interferes with the uptake of calcium in the bones. This gradually makes the bones brittle and prone to fractures.

Skin problems may include dryness of skin followed by redness or even swelling in severe cases.

Eye problems Bulged eyes in graves make them prone to dryness and infections.

Management

You may have lost substantial weight and suffered muscle wasting due to the condition. Watch your diet. Include plenty of proteins and extra calories to compensate the loss.

External supplementation of calcium and vitamin D may have to be given to prevent any bone fracture or twisting.

Lubricating eye drops may be used in graves disease for eye care.

Radioactive Iodine

When taken by mouth, this makes the thyroid gland shrink and become under active. One may actually develop under-active thyroid condition when on treatment with this and may require to take thyroxine externally for some time.

This treatment is conventional and is widely used.

Antithyroid Medications

Propylthiouracil and methimazole  are two widely used anti thyroid drugs which inhibit the production of thyroxine by the thyroid gland. One year treatment with the medication is usually required, after which the condition sometimes subsides permanently. In some cases, relapses may occur.

Beta Blockers

These medicines are given to control heart symptoms during the period thyroid levels normalize.

Thyroidectomy

Surgical resection of the thyroid gland is considered where anti thyroid medication are not tolerated and radioactive iodine cannot be given.

Pregnant women, who cannot opt for other treatment modalities may choose this option.