Hyperthyroidism

Hyperthyroidism is a condition where the butterfly-shaped thyroid gland in your neck produces too much thyroid hormone. This excess hormone speeds up your body's metabolism, affecting nearly every organ and causing a wide range of symptoms.

Common causes

Several conditions can cause hyperthyroidism by triggering the overproduction or release of thyroid hormones.

  • Graves' disease: This is the most common cause of hyperthyroidism. It is an autoimmune disorder where the immune system attacks the thyroid gland, causing it to become overactive. It can also lead to swelling around the eyes.

  • Thyroid nodules: These are lumps that can grow on the thyroid. While usually not cancerous, one or more nodules can become overactive and produce too much hormone. This is more common in older adults.

  • Thyroiditis: This refers to inflammation of the thyroid gland. The inflammation causes stored thyroid hormone to leak into the bloodstream, which temporarily causes symptoms of hyperthyroidism.

  • Excessive iodine: The thyroid gland uses iodine to produce hormones. A high intake of iodine from certain foods or medications, including some heart medicines, can cause the thyroid to make too much hormone.

  • Overmedication: People taking thyroid hormone medication for an underactive thyroid (hypothyroidism) can develop hyperthyroidism if their dosage is too high.

Signs and symptoms

Symptoms can vary from person to person, and some—especially older adults—may have very mild or different symptoms.

Common symptoms include:

  • Weight loss: Losing weight despite having an increased appetite is a hallmark symptom.

  • Heart palpitations: You may feel a rapid, pounding, or irregular heartbeat.

  • Anxiety and irritability: Nervousness, mood swings, and a feeling of being on edge are common.

  • Sweating and heat intolerance: You may sweat more than usual and feel sensitive to heat.

  • Tremors: A fine trembling in your hands and fingers is often noticeable.

  • Fatigue and muscle weakness: Despite a faster metabolism, many people feel weak and tired.

  • Sleep problems: Insomnia and difficulty sleeping are frequent complaints.

  • Enlarged thyroid (goiter): A swelling at the base of the neck may occur, indicating an enlarged thyroid gland.

  • Eye changes: In Graves' disease, this can include bulging eyes, a gritty sensation, and light sensitivity.

  • Changes in bowel habits: You may experience more frequent bowel movements.

  • Menstrual changes: In women, hyperthyroidism can lead to lighter or less frequent periods.

Diagnosis

To diagnose hyperthyroidism, a doctor will consider your symptoms and use blood and imaging tests.

  • Physical exam: Your doctor will look for physical signs like a rapid pulse, an enlarged thyroid gland, and a fine tremor in your hands.

  • Blood tests: A blood test measures the level of thyroid hormones, specifically T4 and T3, and a pituitary hormone called TSH (thyroid-stimulating hormone). In hyperthyroidism, T4 and T3 levels are high, while TSH levels are low because the pituitary gland is trying to slow the thyroid down.

  • Radioactive iodine uptake test: After swallowing a small dose of radioactive iodine, a scan shows how much is absorbed by your thyroid. This helps determine if the gland is overactive and if the cause is Graves' disease or nodules.

  • Thyroid ultrasound: An ultrasound can provide images of the thyroid to check for nodules.

Treatment

Treatment is aimed at reducing the amount of thyroid hormone and depends on the cause, age, and overall health of the person.

  • Anti-thyroid medications: Drugs like methimazole and propylthiouracil prevent the thyroid gland from producing excessive hormones. While effective, they don't always provide a permanent cure.

  • Radioactive iodine therapy: This is a common and effective treatment where radioactive iodine is taken in a pill or liquid. The thyroid gland absorbs the radioactive iodine, which destroys the overactive thyroid cells. This often leads to an underactive thyroid (hypothyroidism), which is then managed with daily hormone replacement pills.

  • Beta-blockers: These medications do not treat hyperthyroidism itself but can quickly help control symptoms like a rapid heartbeat, tremors, and anxiety. They are often used as a temporary measure until other treatments take effect.

  • Surgery: In rare cases, surgery to remove all or part of the thyroid gland is an option. This may be necessary for large goiters or when other treatments aren't suitable. After surgery, lifelong thyroid hormone replacement is typically needed.

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