Charlotte, NC
Pratikshya Thapa, MD
Shruti Kumari, MS4
Jane is a 46-year-old female who works as a fashion designer. She has been very anxious lately, with noticeable weight loss and irregular bowels. She was recently diagnosed with hyperthyroidism by her primary care physician. In the meantime, she is waiting to see an endocrinologist. What advice do you have for her?
The thyroid gland is a small butterfly-shaped gland located at the base of the neck in front of your trachea (windpipe) and esophagus (the tube that connects your mouth to your stomach). The enlarged thyroid gland produces thyroid hormone. Hyperthyroidism occurs when the thyroid gland is overactive and produces too much iodine and many hormones. Women are more likely than men to have hyperthyroidism, affecting younger people more than older ones.
Hyperthyroidism and Hypothyroidism
The thyroid hormone plays a significant role in our body’s metabolism. If too much thyroid hormone is circulating in the body, every body function tends to speed up. The symptoms of an overactive thyroid gland can include nervousness, irritability, increased sweating, or heart palpitations. Sometimes you might have more frequent bowel movements or even lose weight.
In Graves’ thyroid disease alone, which is the most common form of hyperthyroidism, the eyes may look enlarged, or they may even bulge. Some patients may have swollen goiter glands in the front of the neck from an enlarged thyroid gland. The symptoms of hyperthyroidism can include the following:
If your doctor suspects you have hyperthyroidism based on your symptoms, you will do a physical examination. A physical exam can detect an enlarged thyroid gland in the neck, rapid pulse, hand tremors, and increased reflexes. Your doctor can look for a protruding or swollen eye if you have Graves disease. Your doctor will also order simple blood tests to measure your thyroid activity. They are collectively known as thyroid function tests (TFTs): Thyroid-stimulating hormone (TSH), free T4, and total T3.
Here are the blood tests that measure thyroid hormone levels and your enlarged thyroid gland activity:
Treatment plans for hyperthyroidism will depend on the type of hyperthyroidism, how severe of a condition your thyroid is in, age, and other comorbidities. No single treatment is best for all patients with hyperthyroidism. Depending on your situation, your doctor will discuss your treatment options with you and may also refer you to an endocrinologist.
Antithyroid Drugs: Antithyroid drugs (Methimazole & Propylthiouracil) work by blocking the gland’s ability to make new thyroid hormones for hyperthyroidism. Both drugs control the thyroid gland but will not cure hyperthyroidism. Methimazole is preferred among the two due to having lesser severe side effects than Propylthiouracil. These medications have substantial side effects, but your doctor will discuss them with you before prescribing them.
Beta-blockers: These drugs (e.g., atenolol, metoprolol) control the adrenergic symptoms of hyperthyroidism, such as palpitations, anxiety, and tremors. They also prevent the peripheral conversion of T4 to T3 ( T3 is the active form of thyroid hormone). They can start working within hours or days and make you feel better. Do not stop these drugs before talking to your doctor.
Radioactive Iodine (RAI) Treatment: The RAI iodine treatment can cure your thyroid condition by permanently destroying your thyroid gland. However, you must take thyroid hormone medicine pills for the rest of your life to maintain normal thyroid hormone medicine levels in your body.
Thyroid glands use iodine as the raw material to make thyroid hormones. The thyroid gland gets the iodine to produce thyroid hormone from the food we eat. When radioactive iodine (RAI) pills are swallowed, the thyroid gland absorbs the RAI. Then radiation from the RAI pills damages the thyroid hormone in cells, and the thyroid gland produces less thyroid hormone over time. Do note that RAI pills do not affect any other body part because no other organ in the body uses iodine.
Surgical treatment of hyperthyroidism involves removing some or all of your thyroid gland, so it no longer produces thyroid hormones. Surgical removal of the thyroid gland is a permanent solution. However, it is not usually the preferred choice for treatment due to the risk of damage to the nearby parathyroid glands (which control calcium levels in the body) and the nerves to your larynx (voice box). Your doctor may recommend a surgical option when either antithyroid medication or radioactive iodine therapy does not suit you or if surgical removal is necessary for your treatment.
While radioactive iodine and surgery can permanently cure hyperthyroidism caused by Graves disease, a person will still need to take a replacement for hormones for the rest of their lives. Thyroid glands might function normally again after a hyperthyroid phase which usually occurs in postpartum thyroiditis (after pregnancy) or subacute thyroiditis (after an infection). However, in the case of postpartum thyroiditis, the thyroid gland may still overreact in future pregnancies.
Since hyperthyroidism, especially Graves’ thyroid disease itself, may run in families, it is important for your family members to get physical examinations of their thyroid glands to see if they suffer from thyroid problems too.
