Hyperthyroidism

Inflammatory and Immune System, Metabolic Endocrine

Hyperthyroidism, or an overactive thyroid, occurs when the thyroid gland produces more thyroid hormones than the body needs. The thyroid gland is a gland (shaped like a butterfly) that is found below your Adam’s apple in the front of the windpipe. It secretes thyroid hormones that are responsible for the regulation of many of the body’s functions including body temperature, metabolism, growth, and development. If your body produces too much of this hormone, your body’s metabolism may increase and cause excessive weight loss and an irregular heartbeat. You may also experience difficulty sleeping, fatigue, nervousness, and heart palpitations. The most common cause of hyperthyroidism is caused by an autoimmune disorder known as Graves’s disease. 20 million people in the United States have a thyroid-related disease with women 5-8 times more likely to develop hyperthyroidism than men. While this disease is a chronic life-long condition, symptoms can be managed with prompt medical attention and treatment.

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Symptoms

The symptoms of hyperthyroidism are different for each person and may mimic other illnesses or diseases. Older people may not show any symptoms of hyperthyroidism but may be misdiagnosed with depression or dementia. Sometimes, a goiter may form making the neck look abnormally swollen and is caused by an enlarged thyroid. If you have Grave’s disease, you may experience ophthalmopathy (bulging eyes) and develop thick, red skin on your shins and tops of the feet (Grave’s dermopathy). Other symptoms of hyperthyroidism include:

  • Weight loss
  • Nervousness
  • Irritability
  • Shaky hands
  • Rapid heartbeat
  • Irregular heartbeat
  • Diarrhea
  • Fatigue
  • Muscle weakness
  • Sleeping problems
  • Mood swings

Risk Factors

  • Age (older than 60)
  • Being a woman
  • Family history of thyroid disease
  • Pernicious anemia
  • History of thyroid surgery
  • Recent pregnancy
  • Type 1 diabetes
  • Primal adrenal insufficiency (hormonal disorder)
  • Excessive intake of iodine

Diagnosis

Your healthcare provider will first ask about your medical history, including that of your family. You will be asked about any supplements and medications you are taking. Your doctor will also ask about your symptoms and then do a physical exam. Lastly, you may be asked to do some tests, including:

Thyroid tests. There are a few tests that examine your levels of thyroid hormones that circulate through your bloodstream. These include TSH (thyroid-stimulating hormone), T3 (triiodothyronine), and T4 (thyroxine) blood tests. During the test, a small sample of your blood will be taken using a small needle. You may also be asked to do a thyroid antibodies test which will detect if your immune system is creating antibodies that are attacking your thyroid. A positive result in this test will indicate if you have an autoimmune disorder, like Grave’s disease.

Imaging tests. These include a thyroid scan, ultrasound, and a radioactive iodine uptake test. An ultrasound and thyroid scan may reveal that you have nodules on your thyroid or an enlarged thyroid (goiter). A radioactive uptake iodine test measures the amount of iodine your thyroid absorbs after you swallow a small amount. The test uses radioactive iodine as it is seen easily in the imaging test.

Treatments

Treatment for hyperthyroidism usually involves medication. At times, the condition will require radioiodine therapy or surgery. Your treatment will be catered to what is causing the hyperthyroidism and the severity. The purpose of treatment is to regulate your levels to a normal place, relieve symptoms, and prevent long-term health issues. Treatments include:

Medication. Antithyroid medicines are the first line of treatment in helping the thyroid to secrete less thyroid hormone. The most prescribed anti-thyroid medication is methimazole. If you are pregnant, you will be prescribed a different medication, propylthiouracil (methimazole is unsafe for fetuses). Doctors often prescribe beta-blockers to treat uncomfortable symptoms, such as rapid heartbeat, nervousness, and shakiness.

Radioiodine therapy. Another form of therapy calls for the use of radioactive iodine (iodine-131) taken orally with a capsule or liquid. The radioactive iodine targets thyroid tissue, destroying the cells that produce thyroid hormones without damaging other body tissues. Because the thyroid hormone-producing cells were destroyed, you may develop hypothyroidism (low thyroid hormone levels) which is easily treated with thyroid hormone replacement therapy.

Thyroid surgery. Least-used form of treatment for hyperthyroidism. In this surgery, the surgeon removes some to most of the thyroid gland (thyroidectomy). This surgery is indicated for pregnant women or people with a large goiter.

Alternative Treatments and Home Remedies

Hyperthyroidism needs to be treated by a licensed medical healthcare provider. Some natural remedies can interact with your current medications. Further, before taking supplements, you should have a blood test to identify nutrient deficiencies like calcium. Be sure to discuss with your healthcare provider before taking any natural remedies and supplements. The following are supplements and treatments that may help relieve symptoms and supplement deficiencies:

Vitamin D. Helps your body absorb calcium and phosphorus. Studies have shown that low vitamin D levels may be associated with autoimmune thyroid disorders like Grave’s disease and some types of thyroid cancers.

Probiotics. A healthy gut requires beneficial bacteria known as microbiota to help absorb minerals and nutrients. Probiotics contain these live microorganisms and are found in food sources (like yogurt, kombucha, and fermented foods) or can be taken as a supplement. Probiotics have been shown to benefit people who have thyroid diseases and helpful in regulating fluctuating thyroid hormone levels while encouraging the absorption of beneficial micronutrients, including zinc, selenium, and iron.

L-carnitine.  A naturally-occurring amino acid stored in our muscles that is responsible for energy production. A recent study has shown that L-carnitine inhibits the thyroid hormones, T3 and T4, and may be capable of reversing hyperthyroid symptoms. Food sources of L-carnitine are meat (try lean chicken), fish, avocado, tempeh, asparagus, peanut butter, and rice.

Lifestyle Changes

The most important lifestyle modification is dietary. You should avoid eating certain foods that are high in iodine. Highly processed foods and iodized salt are high in iodine. You may also experience excessive weight loss due to overactive metabolic processes from too much thyroid hormone. Talk with a nutritionist about a nutrient-rich diet plan that helps you healthily gain weight. An overactive thyroid can lead to weakened bones due to loss of calcium leeched from the bones. Talk to your doctor about taking a calcium supplement as dairy products contain iodine.

References

Cherney, K. (2018, September 20). Diet and lifestyle tips to help manage hyperthyroidism. Retrieved from Everyday Health: https://www.everydayhealth.com/hyperthyroidism/diet-lifestyle-tips/

Knezevic, J., et. al. (2020, June). Thyroid-gut-axis: How does the microbiota influence thyroid function? Nutrients, 12(6), 1769-. Retrieved from PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7353203/#:~:text=Probiotics%20have%20shown%20beneficial%20effects,selenium%2C%20zinc%2C%20and%20copper.

Kravats, I. (2016, March 01). Hyperthyroidism: Diagnosis and treatment. American Family Physician, 93(5), 363-370C. Retrieved from American Academy of Family Physicians: https://www.aafp.org/afp/2016/0301/afp20160301p363.pdf

Mawer, R. (2018, November 06). L-carnitine: Benefits, side effects, sources, and dosage. Retrieved from Healthline: https://www.healthline.com/nutrition/l-carnitine

Mayo Clinic Staff. (2020, December 05). Grave’s disease. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/graves-disease/symptoms-causes/syc-20356240

Moore, K. (2018, September 28). Thyroid storm. Retrieved from Healthline: https://www.healthline.com/health/thyroid-storm

Reid, J. R. & Wheeler, S. F. (2005, August 15). Hyperthyroidism: Diagnosis and treatment. Retrieved from American Family Physician, 72(4), 623-630. Retrieved from American Academy of Family Physicians: https://www.aafp.org/afp/2005/0815/p623.html

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