Hyperthyroidism and Graves’ Disease 101
Average read time: 7 mins
Imagine putting your foot on the gas pedal. Your car speeds up. You take your foot off the pedal…but it’s stuck. Gasoline is still flooding your engine, and your car is careening out of control. This is what happens when you are hyperthyroid.
Your thyroid gland produces thyroid hormones. It’s like the gas pedal, and its job is to facilitate the delivery of thyroid hormone – which is like gasoline. This helps to power your cells, tissue, organs, and glands throughout your body.
In some cases, like a gas pedal, the whole process gets stuck, leaving your thyroid overproducing thyroid hormone, a condition called hyperthyroidism (an overactive thyroid). The excess hormone speeds up all your body processes, wreaking havoc and creating a host of symptoms.
Causes of Hyperthyroidism
How does this happen? There are several causes:
Graves’ Disease – In autoimmune Graves’ disease, your immune system makes antibodies that attach to your thyroid cells, causing them to overproduce thyroid hormone. This is the most common cause of hyperthyroidism.
Toxic Nodular Goiter / Multinodular Goiter – In this condition, you have one or many active thyroid nodules, and these nodules overproduce thyroid hormone.
Thyroiditis – Thyroiditis is a term that covers a variety of conditions where your thyroid is inflamed. In some cases, thyroiditis triggers your thyroid gland to overproduce hormone. Temporary periods of hyperthyroidism are commonly seen in postpartum thyroiditis and Hashimoto’s thyroiditis.
Medication-Induced Hyperthyroidism – Taking too much thyroid hormone replacement medication (like Synthroid or Nature-throid) can make you hyperthyroid. The heart drug amiodarone (Cordarone) and the drug interferon are also known triggers for hyperthyroidism.
Iodine Exposure – Exposure to iodine (i.e., from supplements, or from iodine contrast in medical tests) can be a trigger for hyperthyroidism.
Pituitary-Induced Hyperthyroidism – Benign tumors, as well as genetic mutations, can cause your pituitary gland to overproduce TSH, triggering hyperthyroidism.
The Risks Factors for Hyperthyroidism
The following factors put you at higher risk of developing hyperthyroidism:
- Your gender – Females are at higher risk of hyperthyroidism
- History – Having a personal or family history of autoimmune disease (for example, multiple sclerosis, psoriasis, rheumatoid arthritis, or celiac disease), or thyroid disease is a risk factor.
- Being pregnant or giving birth within the last year is a risk factor.
- Recently going through a major physical or life stress, such as major surgery, divorce, job loss, or death in the family.
- Cigarette smoking – Past or present cigarette smoking is a risk factor for hyperthyroidism.
- Trauma to your thyroid gland – Whiplash, injuring or breaking your neck, or recent neck surgery – is a trigger factor
- Nutritional deficiencies – Deficiencies in vitamin D and selenium are associated with an increased risk of hyperthyroidism.
The Signs and Symptoms of Hyperthyroidism
If you have even of few of the following signs and symptoms of hyperthyroidism, you should see your healthcare provider for a thorough evaluation.
Energy Level –You may have an unusually high level of energy after the onset of hyperthyroidism, often replaced over time by fatigue and exhaustion.
Sleep Problems – Sleep problems are common, including insomnia and difficulty falling and staying asleep. You may also wake up early and be unable to go back to sleep.
Weight, Appetite, Thirst – When you are hyperthyroid, you may lose weight easily, even with no change in diet or exercise. Or, you may lose (or fail to gain) weight even with an increase in food intake. Feeling hungry, even after eating, is also common, as is feeling thirsty all the time.
Mood and Cognition – When you are hyperthyroid, you may feel anxious or nervous. You may even have panic attacks or be diagnosed with panic disorder. You may startle easily, and feel unprovoked or unusual anger and irritability. You may find it difficult to concentrate and have memory issues. Hyperactivity and fidgeting are common, as are temper tantrums in children and teens.
Neck and Thyroid Area – A characteristic hyperthyroidism symptom is an enlargement in your thyroid, known as goiter. This can make your neck feel swollen or full, and you may be able to feel or even see a lump in your neck. Your neck may also become visibly enlarged, and swallowing may become uncomfortable. Your neck can feel tender, and you may have a sore throat and/or a hoarse voice You may also find yourself bothered by things around your neck, like scarves, ties, or turtlenecks.
Hair Changes – Hyperthyroidism can change your hair, making it thinner, finer, or more easily broken. You may also notice increased hair loss.
Nail Changes – Hyperthyroidism has an effect on your fingernails, causing them to thin, split or break more easily. You may also have an unusual thickening of the fingernails, known as acropachy.
Skin Changes – Hyperthyroidism can cause a variety of skin changes, including a rash on your shins or face, hives (known as urticaria), and/or unusually smooth or warm skin.
Digestion, Elimination, Urination – Hyperthyroidism can speed up your digestion and the transit of food, resulting in episodes of diarrhea or loose stools. You may also urinate more frequently.
Menstrual Changes – When you are hyperthyroid, you may have lighter, shorter, or more infrequent menstrual periods – or your periods may stop completely.
Pregnancy and Postpartum – Hyperthyroidism during pregnancy is associated with excessive nausea and/or vomiting, as well as weight loss (instead of the usual weight gain). Hyperthyroidism is associated with rapid weight loss, depression, and anxiety after childbirth.
Especially in Men – In men, hyperthyroidism can cause a decreased sex drive and erectile dysfunction. It is also linked to reduced or abnormal sperm production and infertility.
Body, Muscles, and Joints – Hyperthyroidism can cause tremors, especially in your hands. You may have muscle and joint aches, pains, and weakness, especially in your upper arms and legs. Patients have described arms that are “too weak to hold a hairbrush,” and legs “too heavy to walk up the stairs.”
Heart and Blood Pressure – Because hyperthyroidism speeds everything up, it’s common to have a rapid heart rate, heart palpitations – and even episodes of atrial fibrillation. You may also have higher-than-normal blood pressure.
Eye Changes – Eye changes can occur in hyperthyroidism, including a dry gritty feeling, and sensitivity to light. Significant eye symptoms are more common in Graves’ disease and include double vision, bulging eyes (known as proptosis), and a noticeable stare. If you can see the whites surrounding your iris, that may be a sign of hyperthyroidism.
Temperature – A well-known hyperthyroidism symptom is feeling hot when everyone else is cold, or feeling hot in cold climates. You may sweat more than usual, or run a low-grade fever. You may also feel intolerant to heat, especially after exercise.
Other Blood Test Results – Abnormal blood test results may point to hyperthyroidism, including:
- Very low fasting glucose (blood sugar) level
- Very low Hemoglobin A1C (HA1C) level
- A low red blood cell count or diagnosis of anemia
- Abnormal liver function tests
- Unusually low cholesterol and triglyceride levels
Other Symptoms – Lastly, some other characteristic hyperthyroidism symptoms include:
- Feeling short of breath, especially when you’re exercising
- Very fast, hyper-responsive reflexes
Seeing Your Doctor
A diagnosis of hyperthyroidism requires a thorough examination with your doctor. The doctor should review your personal and family history, evaluate your risk factors and symptoms, manually examine your thyroid for enlargement or nodules, and look at your eyes, hair, skin, and nails for clinical signs of hyperthyroidism.
Your doctor will also run blood tests, which may include:
- Thyroid stimulating hormone (TSH) test – levels below normal are indicative of hyperthyroidism
- Free thyroxine (Free T4) and free triiodothyronine (Free T3) tests – high-normal or above-normal levels are indicative of hyperthyroidism.
- Thyroid stimulating immunoglobulin (TSI) and/or TSH receptor antibodies (TSHR-AB) – when positive, point to Graves’ disease
Imaging tests such as ultrasound, CT scan, or MRI can evaluate goiter size and characteristics of nodules.
Finally, a radioactive iodine uptake (RAI-U) scan may be done to measure whether your thyroid is absorbing iodine and whether you have nodules that are overproducing thyroid hormone. The RAI-U scan can help diagnose Graves’ disease or toxic multinodular goiter as the cause of your hyperthyroidism.
Treatments for Hyperthyroidism
The goal of hyperthyroidism treatment is to slow down, permanently disable, or (less commonly) remove the thyroid in order to correct the overproduction of thyroid hormone.
Antithyroid Drugs – The antithyroid drug methimazole (Tapazole) is prescribed as a treatment for hyperthyroidism. When you can’t take methimazole, another drug, propylthiouracil (PTU) is sometimes used, but it poses an increased risk of liver damage. Antithyroid drugs can put hyperthyroidism in remission in about 25 percent of patients. For 75 percent, hyperthyroidism relapses over time after you stop taking antithyroid drugs. If you have heart-related symptoms, you may also be prescribed a beta blocker.
Radioactive Iodine (RAI) – In RAI treatment, you take a radioactive form of iodine in a pill or a drink, and it travels to your thyroid gland. Over time, your thyroid shrinks, and cells become incapable of producing thyroid hormone. Sometimes, RAI leaves you with enough remaining thyroid function that you don’t need thyroid hormone replacement medication. But most commonly, RAI destroys part or all of the thyroid, leaving you hypothyroid, and on lifelong thyroid medication.
Surgery – When you can’t take antithyroid drugs, don’t want RAI treatment, or you have a large goiter that’s impairing your swallowing or breathing, surgery is typically performed to remove your thyroid gland. After thyroid surgery, you usually become hypothyroid and will need to take thyroid hormone replacement medication.
up next: A Guide to Optimizing Your Thyroid Medication
New Medical Treatments
Two innovative approaches show promise for treatment of autoimmune Graves’ disease.
Autologous stem cells help boost and balance your immune system, using your own stem cells harvested in a mini-liposuction procedure. It is currently considered an experimental treatment but has had some success with various autoimmune diseases.
Low dose naltrexone (LDN) is off-label, low-dose use of naltrexone, a drug traditionally used to treat addictions. LDN appears to reboot and recalibrate dysfunctional immune systems.
Both autologous stem cell and LDN treatment can, in some patients, lower antibodies, and partially resolve—or even achieve remission from—autoimmune conditions, including Graves’ disease.
Natural and Integrative Options
Many natural and integrative practitioners will hesitate to treat your hyperthyroidism unless you are already being treated with antithyroid drugs. The concern is that the time it takes to respond to natural approaches may be so long that it allows hyperthyroidism to trigger a dangerous and life-threatening condition known as thyroid storm.
Still, natural approaches can complement your hyperthyroidism treatment, and in some cases, reduce your needed dosage of antithyroid medication. Some approaches used by integrative practitioners include:
- Dietary interventions, including a gluten-free diet to reduce inflammation and antibodies
- Traditional Chinese Medicine (TCM), such as herbs and acupuncture
- Vitamin D supplementation
- L-carnitine, which may slow the thyroid
Special Notes About Pregnancy and Breastfeeding
If you have had RAI treatment, you will be cautioned to wait at least six months before attempting to get pregnant.
If you are on thyroid hormone replacement after hyperthyroidism treatment, you should be stabilized on your thyroid medication for several months before attempting to get pregnant.
The RAI-U diagnostic test is never performed when you’re pregnant because the radiation can pose a risk to your baby’s thyroid. If you must have an RAI-U test while breastfeeding, you will need to “pump and dump” your milk for a specified period, until the radiation clears your system and is no longer is a risk to your baby.
If you are taking antithyroid drugs during pregnancy, you will be advised to take PTU during the first trimester, to reduce the risk of birth defects in your baby. After the first trimester, you will be advised to go back to methimazole.
RAI treatment is never given during pregnancy. If RAI is needed while breastfeeding, you will need to discontinue nursing.
Methimazole can be safely taken while breastfeeding.
If you can’t tolerate antithyroid drugs while hyperthyroid and pregnant, your doctor will usually advise that you have thyroid surgery. This surgery is usually performed during the second trimester when it is safest for you and your baby.
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