SparkMD-Frequently Asked Questions about Overactive Thyroid-Hyperthyroidism

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Frequently Asked Questions about: Overactive Thyroid - Hyperthyroidism
Note: Information provided below is intended as a source of information and a guide. For specific details about your own health, speak to your doctor. Revised (4/23/2001) 1. How do I know if my thyroid gland is overactive? 2. If it turns out that I do have hyperthyroidism why did this happen to me? 3. Will I need more tests? 4. Does everyone with an overactive thyroid receive the same treatment? 5. When my thyroid hormone levels are normalized will I become fat? 6. Will I develop “poppy eyes"? 7. I feel pretty good right now. What would happen if I did nothing? 8. What are the complications and risks of treatment? 9. My thyroid is giving me palpitations and making me nervous. What can I do about that so I will feel better right away? 10. What is “subclinical hyperthyroidism?" 11. Can my thyroid spontaneously change from overactive to under active?
1. How do I know if my thyroid gland is overactive?
Answer -There are both classic and subtle symptoms of hyperthyroidism, a. Classic symptoms include: 1. Rapid pulse rate 2. Anxiety 3. Palpitations 4. Nervousness 5. Weight loss 6. Tremors of the hands and tongue 7. Frequent bowel movements 8. Hair loss b. Subtle symptoms of hyperthyroidism are: 1. Infertility in men and women 2. Irregular heart rate (in men and women over age 50) 3. Impotence 4. Muscle cramps
2. If it turns out that I do have hyperthyroidism why did this happen to me?
Answer - There are several different reasons for your thyroid to become overactive and release excessive amounts of thyroid hormone into your blood stream but basically it is because all or part of your thyroid gland is responding to a stimulus other than TSH, becomes inflamed or has its normal function altered by pregnancy or medications. a. Thyrotoxicosis or Graves Disease, most common form of thyroid hormone over activity is believed to be caused by a special protein called an immunoglobulin specifically thyroid stimulating immunoglobulin (TSI) that puts the entire thyroid gland into overdrive. b. Toxic thyroid adenoma-Sometimes it is not the entire thyroid gland but a rogue portion of the thyroid that becomes overactive. c. Thyroiditis (Acute or Subacute) occurs after a viral illness when the thyroid gland becomes inflamed and spills its entire contents of stored hormone into your blood stream. d. Post-partum thyrotoxicosis occurs after a woman delivers a baby. The hyperthyroidism may be fleeting and resolve spontaneously or persist and require treatment. e. Drug induced thyrotoxicosis develops in patients who have been given medication containing an unusually large amount of iodine which is present in drugs like amiodarone (Cordarone™) used to control rapid and irregular heart rhythms and iodine containing cough medicines. Some dyes used for x-rays (CAT scan, IVP, coronary angiography) also have enough iodine to put the susceptible thyroid gland into overdrive and create a hyperthyroid state. f. Patient-induced hyperthyroidism-Thyroid pills are believed to be effective weight reducing pills and sometimes men and women take excessive amounts of thyroid hormone in the mistaken belief that by doing this they will remain slim.
3. Will I need more tests?
Answer: Possibly. Treatment is best when it is tailored to your needs and this depends on precise diagnosis. Blood tests can tell your doctor that you have high thyroid hormone levels but will not tell him why your thyroid gland has become overactive. He/she may want to refer you to an endocrinologist, a doctor who has special training in the diagnosis and treatment of thyroid and other hormone disorders. More blood tests and a special exam called a radioactive iodine uptake (RAIU) may be needed. (RAIU tests are not done in women who are hyperthyroid nursing mothers).
4. Does everyone with an overactive thyroid receive the same treatment?
Answer: No. As with any other medical problem treatment is best when individualized and tailored to each person’s needs This the best way to help each man and woman with hyperthyroidism to become normal again. a. If you have thyrotoxicosis or Graves disease either pills-either methimazole (Tapazoleä) or propylthiouracil (PTU) both designed to minimize excessive thyroid hormone secretion - or radioactive iodine –to inactivate your thyroid gland are both effective. Thyroid surgery which at one time was useful for treating hyperthyroidism is also an option but rarely used today. b. Radioactive iodine therapy is the preferred treatment when hyperthyroidism is caused by a Toxic thyroid adenoma. c. Thyroiditis (Acute or Subacute) commonly causes only a temporary state of thyroid hormone over activity. Nonetheless the sudden excess of thyroid hormone released into your blood stream and the inflammation in and around the thyroid gland will cause a wide range of distressing symptoms. These include fever and neck pain which can be controlled with aspirin or acetaminophen (Tylenolä) Other problems require different treatment. Heart palpitations, anxiety, nervousness and tremor can usually be controlled with short term treatment with pills like propranolol (Inderalä) or ateneolol (Tenormin) ä). Your thyroid gland usually resumes normal function as you recover from subacute thyroiditis and at that time treatment can be discontinued.. On those rare occasions when thyroid hormone levels do not normalize you may be left with an under active thyroid and will need thyroid hormone supplements (see Hypothyroidism below). d. Post-partum thyrotoxicosis- Concern for the health and welfare of the mother as well as her new born baby limit treatment options for the woman who develops an over active thyroid immediately after birth especially if she is eager to nurse. Medications like propranolol (Inderalä) or ateneolol (Tenormin) ä) can be used to minimize symptoms of nervousness palpitations and anxiety and judicious doses of PTU can be used to rein in excessive thyroid hormone production. If hyperthyroidism persists, then treatment with radioactive iodine (RAI) may be needed, but that will require the mother to discontinue nursing and wean the baby and plan to have someone else care for the child in the interval immediately following RAI treatment.. e. Drug induced thyrotoxicosis-Stopping the medication that caused your thyroid to become overactive is the first step. But if the thyroid remains overactive then a course of treatment with pills like methimazole or PTU may be necessary for a while until your thyroid returns to completely normal function.
5. When my thyroid hormone levels are normalized will I become fat?
Answer: Concern for weight after treatment is one of the most common questions asked by men and women with hyperthyroidism. Few recall that weight loss is one of the most common symptoms of thyroid hormone over activity. Further when in a hyperthyroid state men and women can eat voraciously and never gain weight. But this is not the norm. Once thyroid hormone levels are normalized some weight gain, back to normal is inevitable. Thereafter, as is the case for everyone else a regimen of diet and exercise is needed to maintain weight at the desired level
6. Will I develop “poppy eyes”?
Answer: Some men and women whose hyperthyroidism is caused by thyrotoxicosis (Graves disease) can have swelling in the fat behind their eyeballs that will make their eyes protrude. If the muscles regulating the up down and side to side motion of their eyes become thickened they may also have double vision or some other distortion in their eyesight. When the eyes are affected in this way the condition is referred to as thyrotoxic opthalmopathy. Unfortunately, sometimes eye problems persist even after treatment restores normal thyroid function. In that case other therapy directed at the thyrotoxic opthalmopathy is needed.
7. I feel pretty good right now. What would happen if I did nothing?
Answer: Early on in the development of hyperthyroidism symptoms can be mild and even moderately exhilarating. The hyperthyroid state provides a sense of renewed energy and vigor, less fatigue and a sense of vigor, but alas these feelings are often fleeting and often give way to a sense of anxiety, fear, palpitations, muscle weakness, loss of sexual capacity and other distressing and often disabling. Sooner or later treatment will be inevitable.
8. What are the complications and risks of treatment?
Answer: Risks are treatment specific. a. Anti-thyroid pills like methimazole (Tapazole) and propylthiouracil (PTU) occasionally cause a fall in the white blood cell count. When this happens patients usually experience a fever and sore throat. If you are taking Tapazole or PTU and have a fever and sore throat contact your doctor immediately. The doctor will want to see you to determine if the fever and sore throat are an allergic reaction to your medicine or merely symptoms of the flu or a streptococcal sore throat. If the symptoms prove to be an allergic reaction to PTU or Tapazole your doctor will stop those medications immediately so that your blood count can return to normal. b. Patients who have received radioiodine (RAI) treatment of their hyperthyroidism can experience a painful inflammation of their thyroid gland two-three weeks after their RAI treatment. Thereafter the major consequence of RAI therapy is hypothyroidism which will require treatment with thyroid hormone supplements (see below).
9. My thyroid is giving me palpitations and making me nervous. What can I do about that so I will feel better right away?
Answer: Medications like propranolol ( Inderalä) and atenolol (Tenorminä) can be used in conjunction with any other treatment to control symptoms of nervousness, palpitations and anxiety that often accompany hyperthyroidism. Once other treatments have normalized thyroid hormone levels these medications can be safely discontinued.
10. What is “subclinical hyperthyroidism?"
Answer: Early on in the development of hyperthyroidism, before symptoms are apparent thyroid hormone blood tests become abnormal and show the characteristic pattern of a low blood TSH level and a high normal or frankly high thyroxine level. This happens most commonly when doctors order or get the results of thyroid hormone tests during routine screening even when they do not suspect thyroid hormone over-activity.
11. Can my thyroid spontaneously change from overactive to under active?
Answer: Yes it can. For example the hyperthyroidism that develops after a pregnancy may be present but temporary and then return to normal or be occur and then “flame out” leaving the mother in a hypothyroid state. (For more on hypothyroidism click here).