The symptoms of hyperthyroidism, or overactive thyroid disease, can be similar to those of menopause and many other health conditions. But unlike menopause symptoms, the problems caused by an overactive thyroid will continue unless they are treated. The good news is that in most cases, hyperthyroidism can be cured, says Valentine J. Burroughs, MD, who serves as Director of Endocrinology, Diabetes and Metabolism for Highland Medical, P.C., and Montefiore Nyack Hospital.
“An estimated 1% of people have an overactive thyroid, and the problem is much more common in women,” Dr. Burroughs said. If it is not treated, hyperthyroidism can lead to serious problems with the heart, bones, muscles, menstrual cycle, and fertility.
Thyroid hormone helps the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should. In a person with hyperthyroidism, the thyroid gland makes and releases too much thyroid hormone, which speeds up your metabolism.
Possible risk factors for hyperthyroidism include:
- Family history of thyroid disease
- Taking medications containing high amounts of iodine, such as the heart medication amiodarone
- Eating a lot of seaweed and seaweed-based supplements, which contain high levels of iodine
A severe form of hyperthyroidism, called Graves’ disease, tends to occur in younger women. In Graves’ disease, antibodies produced by the immune system stimulate the thyroid, making it produce too much hormone.
Hyperthyroidism can cause nervousness, irritability, moodiness, increased perspiration (sweatiness), rapid heartbeat that tends to be more noticeable at night, hand tremors, and weight loss. Other symptoms can include increased sensitivity to heat, loose stools, weight loss, fatigue, muscle weakness, and difficulty sleeping. A telltale sign of hyperthyroidism is an enlarged thyroid gland, called a goiter, which can appear as a swelling at the base of the neck. Other physical changes can include very smooth skin, protruding eyes, brittle nails, and hair loss.
The doctor will make a diagnosis of hyperthyroidism based on symptoms, a physical exam and blood tests to measure thyroid hormones. The physical exam will include a check for an enlarged thyroid gland, rapid pulse, very smooth skin, eye changes, and a tremor in the fingers or hand. The doctor may perform a thyroid scan to see if the entire thyroid is affected, and a radioactive iodine uptake test to measure the thyroid’s ability to take up iodine, which can help determine the cause.
There are several treatments for hyperthyroidism. Your doctor will recommend an appropriate treatment based on your age, your physical condition, the cause of your hyperthyroidism, and how severe your condition is, Dr. Burroughs says.
The first treatment for hyperthyroidism is medication. There are two anti-thyroid medications available—propylthiouracil (PTU) and methimazole (Tapazole). The medications stop the thyroid gland from producing hormones. These drugs are generally taken for six months to 1 year, until the hyperthyroidism is under control. The doctor also may prescribe a beta-blocker to treat some symptoms such as nervousness, palpitations, and insomnia.
The second step, once thyroid hormone levels are stabilized with medication, is to treat the thyroid with radioactive iodine. This treatment, taken by mouth, destroys overactive thyroid tissue. In some cases, so much of the tissue is destroyed that the person needs to take thyroid replacement medication, called Synthroid.
Surgery to remove the thyroid gland is a last resort, Dr. Burroughs says. “We try not to remove the thyroid gland unless the patient can’t take thyroid medication or radioactive iodine.” After surgery, many patients end up needing to take thyroid replacement medication. “Complications of surgery are far less common in the hands of highly experienced and skilled thyroid surgeons,” Dr. Burroughs noted.
During pregnancy, untreated hyperthyroidism can lead to health problems for the mother and baby. In pregnant women, PTU generally is the treatment of choice.
“There’s no one treatment for hyperthyroidism that works for everyone,” Dr. Burroughs says. “In most cases, once you are diagnosed, you will be referred to an endocrinologist who has expertise in managing thyroid issues. Once treatment has lowered your thyroid hormone levels to a normal range, your primary care physician can continue to monitor your condition.”