(Graves' Disease; Overactive Thyroid)
Hyperthyroidism develops when the thyroid gland becomes overactive and produces too much thyroid hormone. The thyroid gland is a butterfly-shaped gland in the front of the neck. It produces hormones called T3 and T4. They control the body's metabolism.
The Thyroid Gland
Hyperthyroidism may be caused by:
- Graves' disease—Immune system produces antibodies that cause the thyroid gland to overproduce thyroid hormone
- Toxic uninodular goiter—a single area/nodule in the thyroid gland is overactive
- Toxic multinodular goiter—multiple nodules in the thyroid gland which overproduce thyroid hormone
- Autoimmune thyroiditis—inflammation of the thyroid gland which leads to spillage of thyroid hormone into the bloodstream (may later leads to hypothyroidism)
- Subacute thyroiditis—inflammation of the thyroid gland (often later leads to hypothyroidism]]> )
These factors increase your chance of developing hyperthyroidism:
- Sex: female (eight times more common in women than in men)
- Age: between 20-40 years old
- Pregnancy: postpartum thyroiditis (hyperthyroidism followed by hypothyroidism)
- Family history of Graves' disease
- Certain viral infections
Tell your doctor if you have these risk factors.
Symptoms come on slowly. They may be mistaken for stress. As the thyroid becomes more overactive, symptoms may include:
- Unexplained weight loss despite an increased appetite
- Heart palpitations
- Increased number of bowel movements/diarrhea
- Changes in libido
- Muscle weakness and wasting, especially in the elderly
- Heat intolerance
- Enlarged thyroid gland ( goiter]]> )
- Increased sweating
- Lumpy, red thickening of the skin in front of the shins
- Shortness of breath
- Irregular or ]]>no menstrual period]]>
- ]]>Heart failure]]> or ]]>atrial fibrillation]]> , especially in the elderly
The doctor will ask about your symptoms and medical and family history. A physical exam will be done. The exam often reveals:
- Enlarged thyroid gland, also known as a goiter
- Rapid pulse rate
- Warm, moist skin
- Enlarged red prominent eyes (opthalmopathy)
- Prominent reflexes
- Muscle weakness (arms and legs)
- Rash on front of shins
Your doctor may order the following tests:
- Blood tests
- Thyroid stimulating hormone (TSH), currently the best screening test
- Free T4 and free T3—a pattern of a low TSH with high T3 and T4 levels confirms the diagnosis
- Thyroid autoantibodies (TSH receptor antibody)
- Thyroid scan—may be needed to differentiate between Graves' disease and other causes
- Radioactive iodine uptake test—measures how active thyroid is in taking up the iodine
Treatment will depend on:
- Cause of hyperthyroidism
- Pregnancy status
Treatment options include:
Antithyroid drugs work best for Graves' disease. Examples include:
- Carbimazole— Smoking]]> can interfere with how your body uses this medication. If you smoke, talk to your doctor about how to ]]>quit]]> . (not commercially available in US)
- ]]>Methimazole]]> —once daily
- ]]>Propylthiouracil]]> —three times daily. Note: There is a small risk of serious liver damage with this medication.
If the disease goes into remission, you may no longer need medication.
You may need to take beta-blockers . These drugs relieve rapid heart rate and jitters. Examples include:
This is a common treatment in the US. It is the definitive treatment for a toxic nodular goiter. ]]>Radioactive iodine]]> is taken orally. It is then absorbed by the thyroid gland. Once there, it damages most of the thyroid cells. These cells can no longer produce thyroid hormones. Within days, the excess iodine passes out of the body in the urine or changes into a nonradioactive state. You may need to take a daily thyroid hormone replacement supplement.
]]>Surgery]]> is rare for the treatment of hyperthyroidism. It may be an option when medical therapy fails.
After surgery, you will need to take a daily thyroid supplement.
If there are eye symptoms like dry red eyes or double vision, your doctor may prescribe:
- Eye protection before sleep
- Artificial tears
If you are diagnosed with hyperthyroidism, follow your doctor's instructions . You may be referred to an eye specialist.
American Thyroid Association
National Graves' Disease Foundation
Thyroid Foundation of Canada
American Association of Clinical Endocrinologists. Medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocrine Practice . 2002;8:457-469.
American Association of Clinical Endocrinologists website. Available at: http://www.aace.com/ . Accessed November 9, 2009.
Graves' disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated June 2008. Accessed July 7, 2008.
Reducing your risk of hyperthyroidism. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81 . Updated May 2007. Accessed July 7, 2008.
Shomon M. Frequently asked questions on Graves' disease & hyperthyroidism. Thyroid-Info website. Available at: http://www.thyroid-info.com/articles/hyperthyroidism-faq.htm . Updated July 2008. Accessed July 7, 2008.
Subclinical hyperthyroidism. N Engl J Med . 2001;345:512-516.
Van Geest RJ, Sa sim IV, Koppeschaar HP, et al. Methylprednisolone pulse therapy for patients with moderately severe Graves' orbitopathy: a prospective, randomized, placebo-controlled study. Eur J Endocrinol. 2008;148:229-237.
Weetman AP. Graves' disease. N Engl J Med. 2000;343:1236-1248.
Woeber K. Update on the management of hyperthyroidism and hypothyroidism. Arch Intern Med . 2000;160:1067-1071.
1/30/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Nyirenda MJ, Taylor PN, Stoddart M, Beckett GJ, Toft AD. Thyroid-stimulating hormone-receptor antibody and thyroid hormone concentrations in smokers vs nonsmokers with Graves disease treated with carbimazole. JAMA. 2009;301:162-164.
7/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Safety: propylthiouracil. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm164162.htm . Published June 4, 2009. Accessed July 7, 2009.
Last reviewed November 2009 by ]]>Bridget Sinnott, MD, FACE]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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