Hyperthyroidism

Hyperthyroidism (overactive thyroid) is a condition in which your thyroid gland produces

too much of the hormone thyroxine. Hyperthyroidism can accelerate your body's
metabolism significantly, causing sudden weight loss, a rapid or irregular heartbeat,
sweating, and nervousness or irritability.
Thyroid hormones facilitate metabolism. Consequently, if there is an abnormally
high level of thyroid hormones (both T3 and T4) in the blood, there will be an
increased in demand of oxygen, fast metabolism, and increased vital signs.
Graves disease, an autoimmune disorder which causes abnormal stimulation of
thyroid gland is the most common cause of hyperthyroidism.
In addition, tumor in the pituitary gland, emotional shock, stress, and infection
as well as excessive ingestion of thyroid hormones can precipitate the disorder.

Symptoms:

Hyperthyroidism can mimic other health problems, which may make it difficult for your
doctor to diagnose. It can also cause a wide variety of signs and symptoms, including:

Sudden weight loss, even when your appetite and the amount and type of food
you eat remain the same or even increase

Rapid heartbeat (tachycardia) commonly more than 100 beats a minute

irregular heartbeat (arrhythmia) or pounding of your heart (palpitations)

Increased appetite

Nervousness, anxiety and irritability

Tremor usually a fine trembling in your hands and fingers

Sweating

Changes in menstrual patterns

Increased sensitivity to heat

Changes in bowel patterns, especially more frequent bowel movements

An enlarged thyroid gland (goiter), which may appear as a swelling at the base of
your neck

Fatigue, muscle weakness

Difficulty sleeping

Skin thinning

Fine, brittle hair

Older adults are more likely to have either no signs or symptoms or subtle ones, such as
an increased heart rate, heat intolerance and a tendency to become tired during
ordinary activities. Medications called beta blockers, which are used to treat high blood
pressure and other conditions, can mask many of the signs of hyperthyroidism.

Graves' ophthalmopathy
Sometimes an uncommon problem called Graves' ophthalmopathy may affect your
eyes, especially if you smoke. In this disorder, your eyeballs protrude beyond their
normal protective orbits when the tissues and muscles behind your eyes swell. This
pushes the eyeballs forward so far that they actually bulge out of their orbits. This can
cause the front surface of your eyeballs to become very dry. Eye problems often
improve without treatment.
Signs and symptoms of Graves' ophthalmopathy include:

Protruding eyeballs

Red or swollen eyes

Excessive tearing or discomfort in one or both eyes

Light sensitivity, blurry or double vision, inflammation, or reduced eye movement

Clinical Manifestations
1. Due to increased oxygen consumption: insomnia, restlessness, fatigue,
irritability, tremors, nervousness, and hyperactivity
2. Due to heat intolerance: sweating, flushed and warm skin

3. Due to increased metabolic rate: weight loss in spite of increased appetite

4. Due to increased cellular metabolism: increased vital signs and peristaltic
movement
5. Exopthalmus

Diagnostic Findings
1. Enlarged thyroid gland
2. Thrill may be palpated and a bruit is heard at the thyroid arteries sign of
increased blood flow to the area
3. Decreased in serum TSH, increased free T 4, and increase in radioactive iodine
uptake

Medical Management
1. Antithyroid agents lifetime
2. Radioactive iodine therapy destroy overactive thyroid cells
3. Surgery

Hyperthyroidism - Treatment Overview

Hyperthyroidism Guide

There are three treatments forhyperthyroidism. Antithyroid medicine and radioactive

iodine are the ones doctors use most often. In rare cases, surgery may be done.
Hyperthyroidism can lead to more serious problems. So even if your symptoms are not
bothering you, you still need treatment.
The kind of treatment you have depends on your age, what is causing your
hyperthyroidism, how muchthyroid hormone your body is making, and other medical
conditions you may have. Each kind of treatment has benefits and risks. Discuss the
benefits and risks of each kind of treatment with your doctor. For some people, more
than one kind of treatment may be needed.

Initial treatment
Initial treatment for hyperthyroidism usually is antithyroid medicine or radioactive iodine
therapy. If you have a lot of symptoms, your doctor may recommend that you take
antithyroid medicine first to help you feel better. Then you can decide whether to have
radioactive iodine therapy.

Antithyroid medicines work best if you have mild hyperthyroidism, if this is the first time
you are being treated for Graves' disease, if you are younger than 50, or if your thyroid gland is
only swollen a little bit (small goiter).

Radioactive iodine is often recommended if you have Graves' disease and are older than
50, or if you have thyroid nodules (toxic multinodular goiter) that are releasing too much thyroid
hormone. Radioactive iodine is not used if:

You are pregnant or you want to become pregnant within 6 months of treatment.

You are breast-feeding.

You have thyroiditis or another kind of hyperthyroidism that is often temporary.

If you have symptoms such as a fast heartbeat, tremors, sweating, nervousness, or dry
eyes, you may take some additional medicines to treat those symptoms.
Surgery is not usually part of initial treatment. You may need surgery if your thyroid
gland is so big that you have a hard time swallowing or breathing. Or you may need
surgery if a single large thyroid nodule is releasing too much thyroid hormone.

Antithyroid Medicines for Hyperthyroidism

Examples
Generic Name

Brand Name

methimazole

Tapazole

propylthiouracil

Propyl-Thyracil or PTU

How Well It Works

Antithyroid medicines do not always start working right away. Symptoms usually get
better or go away 1 to 8 weeks after you start taking the medicine. It may take as long
as 6 months for your thyroidhormone levels to become normal.
Antithyroid medicines work best if you have mild hyperthyroidism, if this is the first time
you are being treated for Graves' disease, if you are younger than 50, or if your thyroid
gland is only swollen a little bit (small goiter).
If your hyperthyroidism comes back after you have stopped taking the medicine, you
can try taking antithyroid medicine again. But your doctor may recommend radioactive

iodine treatment, because radioactive iodine is more likely to permanently cure your
hyperthyroidism.
In some cases, one type of antithyroid medicine works better than the other.

Methimazole is chosen most often because it can be given once a day, has fewer
side effects, and costs less.
If you are pregnant, propylthiouracil may be safer than methimazole.

Side Effects
All medicines have side effects. But many people don't feel the side effects, or they are
able to deal with them. Ask your pharmacist about the side effects of each medicine you
take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:

Usually the benefits of the medicine are more important than any minor side
effects.
Side effects may go away after you take the medicine for a while.
If side effects still bother you and you wonder if you should keep taking the
medicine, call your doctor. He or she may be able to lower your dose or change your
medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Radioactive Iodine for Hyperthyroidism

Radioactive iodine is a medicine that you take one time. After you swallow it, it is taken
up by your thyroid gland. Depending on the dosage used, the radioactivity in the iodine
destroys most or all of the tissue in your thyroid gland, but it does not harm any other
parts of your body.
While radiation can cause thyroid cancer, treatment ofhyperthyroidism with radioactive
iodine does not increase your chances of getting thyroid cancer.
Radioactive iodine treatment has been safely used on millions of people for more than
60 years.

What To Expect After Treatment

Most people don't feel different after treatment. But a few people may have nausea.

Within a few days after treatment, the radioactive iodine will leave your body in your
urine and saliva. How long it takes will depend on your age and on the dose you
received. Young people get rid of radioactive iodine faster than older adults. Drink plenty
of fluids during this time to help your body get rid of the radioactivity.
Your doctor will give you written instructions. To avoid exposing other people to
radioactivity, it is important to follow your doctor's instructions carefully. He or she will
instruct you on how far to stay away from people, how long you need to sleep alone,
and other ways to stay safe. You will be directed to avoid close contact, kissing, sex,
and sharing cups, dishes, or utensils.
Some general recommendations include:1

Keep your distance from other people, especially children and pregnant women.

Do not sit next to someone in a motor vehicle for more than 1 hour.

Avoid close contact, kissing, or sexual intercourse.

Sleep alone in a separate room.

Use separate towels, washcloths, and sheets. Wash these and your personal clothing
separately for 1 week.

Flush the toilet twice after each use. Rinse the bathroom sink and tub thoroughly after
you use them.

After you take your treatment, you may have follow-up exams every 4 to 6 weeks until
your thyroid hormone levels return to normal.

Why It Is Done
Radioactive iodine has the best chance of permanently curing hyperthyroidism. Doctors
often use it if your hyperthyroidism comes back after you have been treated with
antithyroid medicine. It can also be used if your hyperthyroidism comes back after you
have surgery to remove part of your thyroid gland.

How Well It Works

For most people, one dose of radioactive iodine treatment will cure hyperthyroidism.
Usually, thyroid hormone levels return to normal in 8 to 12 weeks. In rare cases, the
person needs a second or third dose of radioactive iodine.

Risks
Some side effects from radioactive iodine treatment include:

Metallic taste in your mouth.

Dry mouth.

Sore throat.

Neck pain. Radioactive iodine treatment can make your neck swell up or hurt.

Nausea or vomiting, which is usually mild.

Constipation or diarrhea.

Fatigue.

Unusually low (hypothyroidism) or unusually high (hyperthyroidism) thyroid levels.

If you have Graves' ophthalmopathy, it may get worse temporarily after radioactive
iodine therapy.

What To Think About

Most peopledepending on their ages, how much thyroid hormone their bodies make,
and other health conditions they haveare treated first with radioactive iodine.
Radioactive iodine is often recommended if you have Graves' disease and are older
than 50, or if you have thyroid nodules (toxic multinodular goiter) that are releasing too
much thyroid hormone. Radioactive iodine is not used if:

You are pregnant or you want to become pregnant within 6 months of treatment.

You are breast-feeding.

You have thyroiditis or another kind of hyperthyroidism that is often temporary.

You may take antithyroid medicine for several weeks or months before treatment with
radioactive iodine. The antithyroid medicine will lower thyroid hormone levels in your
body and will also lower your chances of having a more serious problem called thyroid
storm. You may also take additional medicines that can make you feel better and help
your thyroid return to normal before you are given radioactive iodine.
Radioactive iodine has been used to treat hyperthyroidism for more than 60 years.
There is no evidence that radioactive iodine causes cancer, infertility, or birth defects.

If you have had radioactive iodine treatment and you want to travel within a few days
after treatment, prepare for any problems you may have at airport security. People who
have had radioactive iodine treatment can set off the radiation detection machines in
airports.