Hyperthyroidism

Do you struggle with any of the following symptoms?

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• Heart palpitations
• Irritability
• Anxiety
• Unintentional Weight Loss
• Increase Appetite
• Insomnia
• Diarrhea
• Hair loss
• Muscle weakness
• Irregular Menstrual Cycles
• Sweating
• Tremors
• Protruding eyeballs
• Enlarged Thyroid
• Tremors
• Nervousness 

What is hyperthyroidism?

Hyperthyroidism is a thyroid condition in which your thyroid is overactive. This indicates that your thyroid is overproducing too much thyroid hormone, known as thyroxine.

In hyperthyroidism, your metabolism is put on overdrive, which is why many patients often experience some common symptoms like diarrhea, unintentional weight loss, and an increase in appetite. 

What are other symptoms associated with hyperthyroidism?

Symptoms that may be associated with an overactive thyroid include unintentional weight loss, anxiety, diarrhea or loose bowel movements, increased appetite, nervousness, hair loss, irregular periods, irritability, sensitivity to heat, increased sweating, palpitations, rapid heartbeat, and insomnia.

While some individuals with hyperthyroidism may experience severe symptoms, others may experience little to no symptoms. 

How do I test for hyperthyroidism?

It is important to see a practitioner who will take a full medical history and assess your symptoms and complete a thorough physical examination.

Your practitioner will order lab tests to assess your thyroid function. These tests usually include a comprehensive thyroid panel including TSH and your free thyroid hormones T4 and T3.

Your Physician may also think it is warranted to assess for an autoimmune cause of your thyroid condition and will run other markers including anti-thyroid peroxidase, thyroglobulin stimulating immunoglobulin, and thyroglobulin antibody.

Along with a thyroid panel, your physician may assess other important markers including iodine, iodine/creatinine ratio, and order thyroid imaging to get a full picture of your thyroid function.

Your physician may also order a lipid panel to assess your cholesterol and triglyceride levels are hyperthyroidism may be linked to low cholesterol and triglyceride levels. 

Example of HIGH Thyroid levels on lab work before Thyroid treatment:

What causes hyperthyroidism?

There are several factors that could cause hyperthyroidism. The most common cause of hyperthyroidism is Graves Disease, an autoimmune attack on the thyroid. Other potential causes of hyperthyroidism may include:

• Excess dietary or topical iodine intake
  • Some sources of iodine include: Iodized salt, dairy, eggs, fish, shellfish, seaweed
  • Certain skincare products, medications and supplements have hidden sources of iodine 
• Thyroiditis
  • Thyroiditis is an inflammation or swelling of the thyroid gland. Thyroiditis can sometimes occur post-partum and may cause symptoms but may also be painless. This inflammation could lead to excess production of thyroid hormone
• Too much thyroid hormone medication
  • If you have been diagnosed with hypothyroidism and are put on thyroid medication, you may be on too much thyroid medication. This is why it is important to always follow-up with frequent blood tests to make sure you thyroid is well controlled. 
• Thyroid Nodules
  • A thyroid nodule/s indicates that there is an excess growth of cells in your thyroid gland. A thyroid nodule can produce excess hormone, causing hyperthyroidism. A thyroid nodule will 

Who is at increased risk for developing hyperthyroidism?

Hyperthyroidism is more common in females than males, affecting 2 out of every 100 females and 2 out of 1,000 males. Hyperthyroidism is also more common in:

• People older than 60 years old 
• If you have a family history of thyroid disease 
• Taking iodine containing medication
• Pregnancy
• If you have a history of:
  • Pernicious anemia
  • Type 1 or 2 diabetes
  • Primary adrenal insufficiency 
  • History of autoimmune disease

How do you treat hyperthyroidism?

The treatments for hyperthyroidism vary depending on your symptoms and your lab and imaging results.

Oftentimes, anti-thyroid medications are prescribed which will prevent your thyroid from making an excessive amount of hormones. Some of the treatments for hyperthyroidism may include: 

• Anti-thyroid medication. Medication may be initiated for temporarily or may need to used long term. This will be assessed with frequent lab testing and follow-up appointments with your physician.
• Beta-blocker medication may be initiated if you are experiencing hyperthyroid symptoms that include tremors and a rapid healthbeat. 
• Other therapies might include radioiodine therapy or surgery.
  • Radioactive iodine therapy will destroy thyroid cells that produce thyroid hormone, therefore inhibiting excess thyroid production. It is important to know, however, that radioiodine therapy may lead to hypothyroidism. If you develop hypothyroidism, it is often easier to treat than hyperthyroidism.
  • While rare, surgery may be necessary in more extreme cases. A part of the thyroid may be removed or the entire thyroid gland might be removed. Typically, patients with large goiters or pregnant women who are unable to take anti-thyroid medication may need to get their thyroid removed. Its likely that surgically removing some or all of your thyroid gland will require you to be on thyroid hormone replacement for the rest of your life. 
• While medication or surgery may be necessary in some cases, its possible that depending on your labs and symptoms, you can be managed with herbal treatment and diet alone.
• Even if you are put on medication or therapy, you may benefit through dietary and supplemental changes. For example, you may require calcium and or vitamin D supplements if they are not being properly utilized in your body due to hypermetabolism.

What happens if I don't treat my hyperthyroidism?

Because your thyroid plays a major role in your metabolism, if it's not regulated or stable, it can wreak havoc on many of your other body systems. Some complications may include:

1. Cardiac problems:
   1. Being in a hyperthyroid state can make your heart work faster and harder, causing palpitations and increased heart rate. This is why its so important to follow your physician's instructions in frequent lab testing and follow-up. While these complications can be seen in hyperthyroid patients, it can als  occur in hypothyroid patients who are on too much thyroid medication.
2. Thyroid Storm:
   1. This is a potentially life-threatening condition when your body releases too much thyroid hormone putting you into a hypermetabolic state. Some symptoms may include sudden fever, deliria, rapid pulse and sweating. This is a medical emergency and you must seek immediate care.
3. Weak brittle bones:
   1.  An excess amount of thyroid hormone can impair your body's ability to absorb calcium. Your bones become weak when they don't obtain enough calcium and can put you at great risk for fractures and osteoporosis. 
4. Infertility:
   1. Excess thyroid hormone can interfere with a females menstrual cycle and can cause her to experience infertility. 
5. Ophthalmic problems:
   1. Certain patients who have hyperthyroidism due to Graves Disease may experience eye problems. If untreated, these problems may lead to loss of vision.

Can hyperthyroidism cause hypothyroidism?

Yes. If you're on too much anti-thyroid medication or have had part of your thyroid removed, its likely that you will become hypothyroid.

Hypothyroid symptoms may include weight gain, hair loss, constipation, fatigue, joint pain, cold intolerance. Frequent follow-ups and lab testing with your Physician can help you keep your thyroid better managed. 

Case Study:

A 57 yo male presented to a clinic with a diagnosis of Graves’ Disease. His prior Physician recommended radioactive iodine, however, the patient wanted a second opinion. He was having significant symptoms including heart palpitations, significant weight loss, extreme hunger, increased heart rate and visual changes. He was undergoing a lot of stress from work and had previous infections. Through shared decision making, we decided to start the patient on methimazole (anti-thyroid medication), a beta blocker, immune support (specifically for autoimmune thyroiditis) and followed up three weeks later. The patient was also referred for a cardiac and ophthalmologic work-up.

I called the patient the next day to see how he was feeling on the medicine, and he said he already felt better and his heart rate was lowering. At his follow-up appointment three weeks later, the patient stated he was feeling significantly better and was no longer getting the adrenaline rush with obeshe was feeling a few weeks prior. The patient was responding well to the medicine and he was instructed to continue at the same dose. The Patient's nutrient status was also checked and he was put on several vitamins and liver support.

The patient came in several weeks later and said overall he was feeling 7.5/10 (10 being the best) and previously was feeling a 3/10. The patient's labs were run and he was responding very well to the medicine and we were able to reduce his thyroid medicine.

The patient is scheduled for a follow-up this month and will repeat thyroid labs and imaging so we can visualize the thyroid gland.