Hyperthyroidism: When the Thyroid Goes into Overdrive
“Any history of thyroid problems?” has become a common question in the doctor’s office when a person is feeling a bit off. More awareness is being raised around this small gland and its incredible influence on the body.
Thyroid disease is a blanket term used to refer to any condition in which the thyroid functions abnormally and usually refers to the thyroid over-performing or underperforming. According to the American Thyroid Association, approximately 20 million Americans have some kind of thyroid disease. The majority of those affected by thyroid disease are women. Women are reportedly 5 to 8 times more likely to have thyroid problems than men, though the reason for this is unknown.
So what exactly is the thyroid, why does it stop working correctly, and can it be fixed? Keep reading for answers to these important questions.
What Is the Thyroid?
The thyroid is a butterfly-shaped gland located near the bottom of the neck, just below the Adam’s apple. If one has an enlarged thyroid, then he or she will probably feel a little bulge in the lower neck that moves when swallowing. The thyroid is essential to overall health, and it affects just about every system in the body. It has an especially strong impact on metabolism.
What Does the Thyroid Do?
The thyroid produces thyroid hormones called thyroxine (T4) and triiodothyronine (T3). The thyroid partners with the pituitary gland to determine how much T3 and T4 need to be produced. Once the thyroid produces the hormones, T3 and T4 are released into the bloodstream where they are carried throughout the body to help regulate body processes such as heartbeat, metabolism, temperature, breathing, cholesterol levels, and women’s menstrual cycles. Sometimes the information in the body gets relayed incorrectly, causing the thyroid to overproduce, resulting in a condition called hyperthyroidism. Hyperthyroidism can cause serious health risks if left untreated.
Causes of Hyperthyroidism
There are a few different conditions that can cause the thyroid to go into overdrive. Common culprits are an inflamed thyroid, an autoimmune disorder, and too much thyroid medication.
According to the American Thyroid Association, the most common cause of hyperthyroidism is Graves’ disease. Graves’ disease is an autoimmune condition. An autoimmune condition means that the body’s immune system mistakes healthy cells for dangerous cells and attacks them. In the case of Graves’ disease, the immune system mistakes thyroid cells for foreign invaders and attacks and destroys them. This autoimmune response causes the thyroid to go into overdrive, and drives up hormone production of T3 and T4.
Those with Graves' disease may also develop Graves' ophthalmopathy, which can manifest as eye pain, sensitivity to light, double vision, and in rare instances, vision loss.
Hyperthyroidism is sometimes caused by thyroiditis, or inflammation of the thyroid gland. Thyroiditis is usually caused when antibodies attack the thyroid, and so it is thought to be an autoimmune response similar to Graves’ disease. In the case of thyroiditis, the thyroid responds to the attack in one of two ways, by over-producing or under-producing. If it overproduces, the patient is diagnosed with hyperthyroidism and sometimes Graves’ disease depending on the antibodies that are detected. If the thyroid underproduces, then the patient is diagnosed with hypothyroidism, usually Hashimoto’s disease.
Thyrotoxicosis is a condition that arises when there is too much thyroid hormone in the bloodstream. Causes of thyrotoxicosis include diseases such as Graves’ disease or thyroiditis. But thyrotoxicosis doesn’t have to accompany an underlying disease. Thyrotoxicosis can occur when someone with an under-producing thyroid takes too much thyroid medication. In this case, the hyperthyroid symptoms would not be caused by a disease, but the patient would still have the condition of thyrotoxicosis.
Toxic Nodular or Multinodular Goiter
In some cases of hyperthyroidism, the overproduction of the thyroid hormones may be caused by one or more nodules, or lumps, on or in the thyroid gland. This condition is called toxic nodular or multinodular goiter. Sometimes these nodules can contain functioning thyroid cells, which may induce hyperthyroidism because too much thyroid hormone is being produced. If the nodules are filled with blood or fluid, then they are cysts, or noncancerous. If the nodules contain malignant cells, then they are cancerous. Treatment for the nodules will vary depending upon the type of nodules, the size of the nodules, and the symptoms they are causing.
Symptoms of Hyperthyroidism
Regardless of the cause, symptoms are usually consistent across most hyperthyroidism cases. However, hyperthyroidism can be tricky to diagnose since its symptoms mimic those of several other health problems.
Common hyperthyroidism symptoms include:
|Heat intolerance||Nervousness and anxiety|
|Excessive sweating||Increased bowel movements|
|Mood swings||Rapid heartbeat (more than 100 beats per minute)|
|Muscle weakness||Heart palpitations or irregular heartbeat|
|Fine, thinning hair||Weight loss without change to diet or exercise routine|
|Brittle nails||Lack of focus and concentration|
|Goiter, or enlarged thyroid||Lighter and/or less frequent menstrual cycles|
|Hand tremors or shaking||Chronic fatigue but difficulty sleeping|
A diagnosis of hyperthyroidism usually consists of a physical exam and blood tests. The doctor will examine the patient for any signs of a goiter, or enlarged thyroid. If hyperthyroidism is suspected, blood tests will be ordered to check thyroid hormone levels and to check for antibodies.
Common blood tests used to diagnose hyperthyroidism include:
- T4 and T3 tests: These tests reveal the amounts of T3 and T4 in the blood and can indicate if the thyroid is over-producing them.
- Thyroid-stimulating hormone (TSH): The amount of TSH in the blood is typically low with hyperthyroidism cases, so a low result on this thyroid function test will help point the doctor toward hyperthyroidism.
- Thyrotropin receptor antibodies (TRAbs): This test can help identify an autoimmune response if antibodies against the thyroid are found in the blood.
In addition to blood tests, the doctor may order physical tests if thyroid nodules are felt or suspected. These might include ultrasounds and biopsies to rule out cancerous nodules. Imaging tests, such as thyroid scans can help your health care provider determine the exact cause and type of thyroid disorder you have.
Hyperthyroidism may be treated in a variety of ways.
Anti-thyroid drugs work by prohibiting the thyroid from producing thyroid hormones. This method of treatment has proven successful in approximately 20-30% of patients who use it to treat hyperthyroidism caused by Graves’ disease.
Radioactive Iodine Treatment
Thyroid cells need iodine to produce thyroid hormones and will take up any form of iodine in the bloodstream. Sometimes a physician will treat hyperthyroidism with a radioactive iodine medication. It is taken orally in pill form. When the patient swallows the pill, the radioactive iodine releases into the bloodstream. From there, the thyroid cells pick up the radioactive iodine. The radioactive iodine then does its job of destroying the thyroid cells. Sometimes multiple radioactive iodine treatments are needed before enough thyroid cells have been destroyed to bring thyroid hormone levels back to normal.
Once a patient begins treatment for his or her hyperthyroidism, symptoms should start to improve and disappear. However, some cases of hyperthyroidism are more severe than others and do not respond well to initial treatments. In these cases, surgery may be recommended to remove part or all of the thyroid gland.
In the case of a partial thyroidectomy, it is possible that the remaining portion of the thyroid may return to normal function. However, if it does not, then the patient will need to start taking a thyroid hormone supplement. Patients who undergo a total thyroidectomy will also need to start a thyroid hormone supplement and will remain on the treatment the rest of their lives.
Additionally, surgery may be performed to remove nodules on the thyroid. Nodules may be removed whether they are benign or cancerous. Even benign nodules can cause the thyroid to malfunction and might need to be removed. If the nodules are removed and the thyroid returns to normal functioning, then no further treatment may be necessary.
Beta blockers are a type of physician-prescribed drug that can block the action of thyroid hormones. For instance, beta blockers can help slow your heart rate, soothe anxiety, and stop your hand tremors. They don't decrease thyroid hormone levels, but they can help mitigate the effects so that you feel better.
Hyperthyroidism patients who are looking for a natural way to treat an overactive thyroid may find a friend in the amino acid L-carnitine. Amino acids are a critical component of a healthy body. They help the body build protein and make chemicals that are required for healthy functioning organs, including healthy brain function.
University of Maryland Medical System researchers suggest that L-carnitine may contribute to treating hyperthyroidism by blocking the thyroid hormone. If this is true, and L-carnitine does block the thyroid hormone, then sufferers of an overactive thyroid may be able to reduce the amount of thyroid hormone being produced and relieve their symptoms.
While it is possible that L-carnitine may benefit hyperthyroid patients, it’s best to take a balanced mixture of all essential amino acids to make sure that the blood concentration of amino acids is optimal. Also, those battling an overactive thyroid should always discuss alternative treatment options and any supplements with a physician before starting them.