Overactive Thyroid (Hyperthyroidism)




Overactive thyroid is medically known as hyperthyroidism.


Hyperthyroidism is a common endocrine disorder. Women are affected much more commonly than men.


Hyperthyroidism can be easily diagnosed with a blood test.  



Symptoms of Hyperthyroidism:  




Common symptoms due to hyperthyroidism:


1. Weight loss


2. Shakiness


3. Anxiety


4. Irritability


5. Palpitations


6. Tiredness


7. Feeling hot all the time when other people are feeling



8. Thinning of hair


9. In women, hyperthyroidism can also lead to irregular menses and sometimes lack of menses  



Causes of Hyperthyroidism



Common causes of hyperthyroidism:



1. Too large of a dose of thyroid hormone


2. Graves' disease


3. Toxic multinodular goiter


4. Subacute Thyroiditis 


5. Post-partum (post-delivery) Thyroiditis


6. Painless Thyroiditis


7. Drugs such as amiodarone, interferone.


8. Ovarian Tumor (a rare cause)


9. Molar pregnancy (a rare acuse)


10. Early Pregnancy


11. TSH producing pituitary tumor (extremely rare).   




Graves'  Disease



Graves' disease is an autoimmune disease of the thyroid gland. 


In this disease, your body starts producing antibodies which are directed at the thyroid gland. These antibodies are stimulatory in nature and thus force the thyroid gland to produce more and more thyroid hormone. Large quantities of thyroid hormone produce symptoms of hyperthyroidism (overactive thyroid).


In addition, some patients, experience eye symptoms.These include bulging of the eyes, the feeling of a foreign body in the eyes, excessive dryness of the eyes, blurry vision and double vision. Sometimes, eyesight may be in danger and requires immediate medical attention.


Rarely patients experience skin symptoms, usually in the lower legs, in the form of marked thickening of skin.



What Causes Graves' Disease?  



Why does your immune system start to attack your own thyroid cells as if they don't belong to you? Strange, isn't it?


While we don't know the exact root cause for this phenomenon, here are some of the insights:


1. Genetics


2. Stress, especially anxiety, worries, fear.


3. High Carbohydrate diet.


4. Vitamin D deficiency.




Treatment of Graves' Disease



Treatment of Graves' disease includes:



1. Low carbohydrate diet. Click here for Dr. Z's diet.


2. Counselling to alleviate fear, worries and anxiety. Please refer to my book, "Stress Cure Now."


3. A good dose of Vitamin D. Please refer to my book, "Power of Vitamin D."


4. Drugs vs. Radioactive Iodine vs. Surgery




Drugs vs Radioactive Iodine vs Surgery:



Treatment options for Graves' disease include:


1. Anti-thyroid drugs (Tapazole or PTU) for 18 - 24 months or even longer.


2. Anti-thyroid drugs (Tapazole or PTU) in the acute phase

followed by administration of radioactive iodine. 


3. Surgery, which is needed only in rare situations, when the above two choices are not feasible.



Your doctor (an endocrinologist) should discuss pros and cons of each treatment option with you.


Below is an outline of pros and cons of each treatment option.



Antithyroid Drugs



These drugs are used to control symptoms of hyperthyroidism.


Tapazole (methimazole) and PTU (propylthiouracil) are the two anti-thyroid drugs available in the US.


Treatment with an anti-thyroid drug for a period of 18-24 months can result in about a 50% cure rate once the drug is stopped.


In others, hyperthyroidism can recur upon discontinuation of the drug.


These anti-thyroid drugs are generally well tolerated, but occasionally side-effects may develop which include skin rash, liver toxicity and suppression of bone marrow resulting in a decrease in the number of white blood cells, predisposing the patient to serious life-threatening infections.


Therefore, these drugs should be prescribed only by endocrinologists, who are experienced in using these drugs.



Radioactive Iodine



Radioactive iodine is used in the treatment of Graves' disease, thyroid cancer and occasionally, a multinodular goiter.


In the treatment of Graves' disease, radioactive iodine is used in very small amounts (usually about 9 - 12 mCi)  However, this dose is enough to pretty much kill the thyroid gland.


Radioactive iodine usually takes about 2-3 months to be effective.


Most patients become hypothyroid, usually within a few months of treatment and then require replacement with thyroid hormone in the form of pills, for the rest of their life.


In most people, one dose of radioactive iodine does the job, but in some patients, more than one dose is required to control hyperthyroidism.


Radioactive iodine must be used cautiously in patients who also have Graves eye disease, as there is a potential to aggravate the eye condition. This problem can be avoided by giving steroids such as Prednisone before and after radioactive iodine treatment.


Radioactive iodine must not be used in pregnant patients.   





This article was written by Sarfraz Zaidi, MD, FACE. Dr. Zaidi specializes in Diabetes, photoEndocrinology and Metabolism.



Dr. Zaidi is a former assistant Clinical Professor of Medicine at UCLA and Director of the Jamila Diabetes and Endocrine Medical Center in Thousand Oaks, California.



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