Hyperthyroidism

What is Hyperthyroidism?

Hyperthyroidism is a condition characterized by the overproduction of hormones by the thyroid. This small bow tie-shaped gland weighs less than an ounce, but it’s a real heavyweight when it comes to impacting our health. The thyroid is responsible for the body’s metabolism, and plays a key role in many critical functions such as heart rate, respiration, and digestion. In a sense, the thyroid and the hormones it produces are like the engine of the body. Our bodies cannot operate and stay alive without our thyroid.

Two important hormones are produced by the thyroid: triodothyronine (T3) and thyroxine (T4). The “T” numbers refer to the number of atoms in each respective molecule. T4 is the major player, and literally influences every cell of the body. These hormones are responsible for such critical functions as enabling the cells to absorb oxygen, and the manufacture of the protein ribonucleic acid (RNA), which is so important to genetic functions. Another hormone released by the pituitary, a pea-sized gland located at the base of the neck, is called thyroid stimulating hormone (TSH). The main function of TSH is to regulate the amount of T3 and T4 that the thyroid produces. If the thyroid produces too much T3 and T4, despite the policing action of TSH, then hyperthyroidism occurs and the result is an abnormal increase in the body’s metabolism. This can result in many health problems, both physical and mental.

The term hyperthyroidism can be applied to any disease which cause’s abnormally high levels of thyroid hormones. Hyperthyroidism goes by many names, including: thyrotoxicosis, diffuse toxic goiter, Graves’ disease (the most common form of hyperthyroidism), Basedow’s disease, and Parry’s disease. Hyperthyroidism is about ten times more likely to affect women than men. It is found in about one out of every 1000 women in the United States. Most cases occur in individuals over the age of 15, but it occasionally is passed to newborns from mothers with Graves’ disease (neonatal Graves’ disease), or in a form called occult hyperthyroidism that is found primarily in senior citizens over the age of 65.

What Are the Symptoms of Hyperthyroidism?

There are many signs that are associated with hyperthyroidism. Some of the most common are:

• Sudden weight loss, often accompanied by increased appetite and increased intake of calories.
• Nervousness
• Restlessness
• Confusion
• Irritability
• Anxiety and/or anxiety attacks
• Profuse sweating
• Tremors, usually in the hands and fingers
• Shortness of breath
• Fatigue
• Muscle weakness
• Heart palpitations, or irregular heartbeat (arrhythmia), or rapid heartbeat (tachycardia).
• Difficulty sleeping
• Increased sensitivity to heat
• More frequent bowel movements
• Irregular menstrual cycles and/or decreased menstrual flow
• Enlarged thyroid (goiter) that appears as swelling at the base of the neck.
• Graves’ ophthalmopathy (bulging eyes that may be red and swollen; excessive teariness; blurred vision; increased light sensitivity).

Many times patients will have very few symptoms, and it may take years for them to become noticeable. Elderly patients can be particularly difficult to diagnose, as their symptoms may be minimal and easily mistaken for other conditions. They often will experience fatigue during normal activities, increased sensitivity to heat, and rapid heart rate.

Thyroid storm is an acute form of hyperthyroidism that can manifest itself suddenly. It may show the typical symptoms as well as fever, confusion, emotional swings, and in severe cases psychosis or even coma.

What Causes Hyperthyroidism?

The defining characteristic of hyperthyroidism is excessive amounts of thyroid hormones. There are several common ways that this occurs:

• Graves’ disease is the most common type of hyperthyroidism. Graves’ is actually an autoimmune disease whereby the immune system mistakenly identifies the thyroid as an invader to be attacked. It sends out antibodies to wage war against the thyroid as if it were a virus or bacteria. The antibodies can damage the thyroid and result in hyperthyroidism. Graves’ sometimes afflicts the skin on your lower legs and/or at the back of your eyes. Researchers have not yet identified the exact cause of Graves’ disease.
• Thyroiditis:  This is simply a fancy name for an inflamed thyroid gland. The inflammation, often for unidentified reasons, causes hormones that are normally stored in the gland to leak into your system. Most forms of thyroiditis are painless, except for a rare type calledsubacute thyroiditis. Thyroiditis is somewhat common in women after pregnancy (postpartum thyroiditis).
• Hyperfunctioning thyroid nodules:  Sometimes individuals will develop a growth within the thyroid called an adenoma. These are usually benign lumps that become walled off from the main body of the gland, and may cause swelling of the thyroid, as well as the production of abnormally high levels of hormones. Scientists are still puzzled by what causes these nodules, and as to why they cause hyperthyroidism. This condition is also known as toxic adenoma, toxic multinodular goiter, and Plummer’s disease.

What Complications Can Occur Due to Hyperthyroidism?

Hyperthyroidism, if left untreated, can lead to several common complications:

• Heart problems: Serious heart conditions can result from unchecked hyperthyroidism. One of the worst is called congestive heart failure. This is a dangerous disorder whereby the heart cannot pump sufficient amounts of blood to meet the needs of the body. Atrial fibrillation is another possible coronary complication that is a heart rhythm disorder. Tachycardia (rapid heart beat) can also result from hyperthyroidism.
• Osteoporosis: The thyroid gland also produces a hormone called calcitonin that plays a role in regulating calcium levels in the body. Abnormally high thyroid hormone levels make it more difficult for your bones to absorb sufficient amounts of calcium. This can lead to weak, brittle bones.
• Irritated skin: Some forms of hyperthyroidism can lead to skin redness and swelling, especially on the shins and feet.

How Can I Know if I Have Hyperthyroidism?

There are various tests available to help nail down a diagnosis of hyperthyroidism:

• Basal temperature:  This is one of the best indicators of thyroid function, and can accurately and easily be done at home. Basal temperature measures the body’s temperature while at rest. Here’s the best way to do it:

ü       Have a thermometer sitting by your bedside that you can grab first thing upon awakening.

ü       Place it under your armpit, and crimp your arm closed to keep it in place.

ü       Sit quietly on the bed without moving for a full ten minutes.

ü       Take a reading.

ü       Repeat for two more mornings.

ü       Take the average temperature for the three readings.

ü       If the average temperature is over 98.6 F, you may well have hyperthyroidism.

ü       Take this information and compare it any other symptoms you may have, and if it all points to a good chance of thyroid dysfunction, see your health care provider for further testing.

Hyperthyroidism is something you do not want to miss or ignore. You certainly do not want to let it go and risk serious complications such as a thyroid storm. At the same time, you also do not want to subject yourself to certain diagnostic tests or treatments if they are not necessary. This is why it is so important to be educated about your own personal health and the options available to you. We must be proactive about health and treatment issues, and not be led around blindly by the medical profession.

• The next logical step is to see a health care provider, hopefully one that you know and trust, and get a thorough examination. Some hyperthyroidism issues that may come out during an exam are tremors in your fingers (best tested when your hands are extended), changes in the appearance or function of your eyes, changes in the way you swallow, moist and/or warm skin, overactive reflexes, and irregular heartbeat. Talk to your health care provider about your symptoms, and decide together if blood tests are appropriate.
• Blood tests are available that directly measure the level of T4 in your system and another one that takes a look at how much TSH you have present. Abnormally high amounts of T4 point to possible hyperthyroidism. The opposite if true with TSH. If the levels are low or non-existent, this also is an indicator of an overactive thyroid. TSH levels are important, because this is the hormone that regulates how much T3 and T4 your thyroid produces. These blood tests are especially useful at diagnosing folks with borderline symptoms, as is often the case with elderly patients.
• If the evidence is pointing to hyperthyroidism, there are other tests available that can help determine the cause and extent of the condition. However, these are not without risk, so use wisdom before submitting to them:

ü       Radioactive iodine uptake test (RAIU):  This diagnostic procedure involves the oral consumption of a small amount of radioiodine (radioactive iodine), and is used to discover the type of hyperthyroidism a patient might have. Since iodine in the body is naturally collected and stored by the thyroid gland, the test involves tracking, with the help of the radioactivized iodine, the amount of iodine absorbed by your thyroid. A high rate of absorption indicates either Graves’ disease or hyperfunctioning nodules as the cause of the overactive thyroid. A low rate of absorption points to thyroiditis as the probable cause. Patients are checked for the amount of iodine in the thyroid over a period of up to 24 hours. RAIU has its risks. These include exposure to radiation, as well as possible allergic reactions to the radioiodine. Be particularly careful if you have an allergy to dietary iodine or shellfish.

ü       Thyroid scan:  This test is more invasive, and therefore more risky. It involves the injection of a radioactive isotope into your bloodstream (usually through a vein inside the elbow). Then the patient lays back on a table while pictures are taken of the thyroid over a period of time. This is also used to help determine the type of hyperthyroidism and amount of inflammation or involvement of the gland.

ü       There is an option that involves both of these tests being performed simultaneously, and it just requires an oral dose of radioiodine, with no injection. If you feel the need for this kind of testing, please push for this safer and less expensive option. Unfortunately, if you do not request it, it is not likely to be offered to you.

ü       Sometimes other imaging technology (such as ultrasonography, magnetic resonance imaging (MRI), or (CT) computed tomography scan) is suggested, but be careful of these. If you feel one is warranted, I would avoid a CT if at all possible. They expose you to a lot of radiation, about five times the amount of a normal x-ray.

As far as treatment goes, mainstream medicine’s answer is long-term use of dangerous drugs such as radioactive iodine or anti-thyroid medications like Tapazole. For extreme cases of advanced hyperthyroidism, they may possibly be warranted, but they are best avoided if possible.

There is some indication that diet can play a role in both preventing and treating hyperthyroidism. Certain vegetables called brassica vegetables can naturally help to suppress an overactive thyroid. These include turnips, peaches, pears, broccoli, cabbage, kale, spinach, cauliflower, and brussel sprouts.