Hyperthyroidism

Thyrotoxicosis is an overactive thyroid with symptoms of hyperthyroidism.

Did you know?
Thyroid hormone is essential for brain development as the baby develops in pregnancy. It is essential to monitor thyroid closely during pregnancy. The baby does not have a thyroid for the first 12 week as it develops

You may not be able to concentrate well if you have an overactive thyroid as your brain is like a butterfly flitting from one idea to the next. This is especially the case if you are doing exams.. Ask your doctor

Hyperthyroidism can be due to

  1. Graves disease (younger person)
  2. Toxic multinodular goitre (older person)
  3. Toxic nodule
  4. Effect of other medications
Symptoms
  • Tremors (trembling),
  • Weight loss,
  • Increased appetite
  • Frequent opening of bowels
  • Anxiety
  • Palpitations
  • Poor sleep
  • Irritation
  • Eye symptoms

Hyperthyroidism is almost never due to cancer of the thyroid.

Hyperthyroidism– Uptodate.com

 

 

Nodule in the thyroid with hyperthyroidism

Toxic nodule

This is usually when a nodule is present in the thyroid gland secreting thyroid hormone. There may be minimal eye signs (lid-lag, prominent stare). However there will not be eye signs of Graves disease. there is no risk of developing exopthalmos (bulgy eyes)

A nodule in the thyroid may develop from a single abnormal cell ” A Clone”. This single cell multiplies and becomes a non cancerous nodule and secretes more hormone than you require. This is called plummer’s syndrome. This is best treated with surgery or Radioiodine. You may be able to feel the nodule or it may be picked up on ultrasound. If there are several such nodules, this can be a Toxic Multinodular goitre.

Thyroiditis. 

This is inflammation of the Thyroid following on from a viral illness. the virus may attach itself to the thyroid cell and your body in an effort to destroy the virus will launch antibodies against it. The thyroid gets damaged as this is the battlefield. This usually recovers completely in about 6 – 12 months.

Grave’s Disease

This is probably the most common cause of hyperthyroidism in perons under the age of 50. This is an auto-immune condition and you may have inherited this predisposition from your parents.

Autoimmune condition is where your body produces antibodies against itself. Usually antibodies are produced to fight infections and occasionally the virus mistakes parts of you ( Joints, thyroid, bowel) to be part of the virus. It then mounts an immune attack and your organ gets damaged in the battle. eg Hashimotos thyroiditis, Coeliac disease

When your antibodies attack your thyroid, initially it causes leakage of stored thyroid hormone into your blood. The thyroid is then pushed to produced to produce more thyroid hormone.

However these antibodies attack the tissues behind the eyes and cause exopthalmos (both eyes) or proptosis (one eye). In extreme cases it can affect vision. urgent treatment is required

Treatment options.

Tablets ( Carbimazole / Propylthiouracil) These tablets block your thyroid from producing thyroid hormone. The blood supply to the gland reduces and the gland becomes less swollen. The treatment can be either a

  • TITRATION regime where the dose of medication is started at a high dose and then gradually brought down
  • BLOCK and REPLACE regime. The full dose of medication (Thyroid Block) is given and replacement thyroxine is given

The course of treatment is 18 months to 2 years. In about 50% of cases, the antibodies settle down and the gland recovers normal function. This provides the ONLY CHANCE for recovery of the natural thyroid without need for lifelong medcation.

 

Carbimazole Side effects – medicines.org

Propyl thio uracil side effects – medicines.org

Medications used in hyperthyroidism uptodate.com

Radio iodine (400 – 800 mBEQ) Radioactive iodine is used to destroy the thyroid gland permanently. You will need to be off work for a few days, avoid being close to other people, pregnant women and children. It cannot be used if you are pregnant. You are exposed to a small dose of radiation but there has not been any evidence of long term ill effects (eg no increase in thyroid cancers). It is a drink or a capsule that you swallow. The radioactive iodine is mostly eliminated in about 96 hours.

Radioiodine

You dont glow bright Green! it is a very small amount of radioactive iodine

Surgery Very effective and permanent treatment. Carries risk of Anaesthesia and Surgery

Pros

  • Very effective permanent treatment
  • No risk of radiation
  • Better if the eyes are actively inflamed or at risk
  • Better if thyroid gland is large or cosmetic worries
  • Better if planning pregnancy
  • Better if thyroid not coming under control

Cons

  • Risk of hoarseness of voice (nerve damage)
  • Calcium problems (low calcium due to damage to parathyroid)
  • Infection, bleeding
  • You will have to take levothyroxine tablets lifelong
  • Some people will require calcium tablets as well.

 

Hyperthyroidism is associated with bone loss. Osteoporosis (brittle bones) are seen if your TSH is very low (hyperthyroidism). Ensure you take plenty of vitamin D (1000 units per day) and calcium (1000 mg per day)