The Body Diaries: Hyperthyroidism
Thyroid disease affects an estimated 27 million Americans, but only 14 million of those cases ever end up being diagnosed. This is because the thyroid hormone interacts with so many different parts of your body that the symptoms of an imbalance can be widespread and seemingly unrelated, making it difficult to pinpoint the cause of your problems.
If you’re experiencing symptoms like unexplained weight loss, hunger, tremors or nervousness, you could possibly have an overactive thyroid, also known as hyperthyroidism.
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What is hyperthyroidism?
Your body’s ability to metabolize, or convert fuel into energy, relies on a series of hormone-secreting glands each telling the other what to do. Your thyroid gland, located in your neck, has the very important job of converting iodine into the thyroid hormones thyroxine (T4) and triiodothyronine (T3). When thyroid hormone levels in the blood drop too low, the hypothalamus gland, located in the brain, releases a hormone that communicates with the pituitary gland, also in the brain. The pituitary gland then releases another hormone to stimulate the thyroid gland to produce more T3 and T4.
Since thyroid hormones interact with so many different parts of your body, the symptoms of a thyroid issue can be diverse. The most common form of thyroid disease is hypothyroidism, or an underactive thyroid. Those suffering from hypothyroidism experience symptoms like unexplained weight gain, a sensitivity to cold, constipation, depression and heavy menstrual cycles. Although it’s less common, hyperthyroidism, or when the thyroid produces too many hormones, can be just as hard on your system and its opposing symptoms just as challenging to live with.
If you’re suffering from an overactive thyroid, you may experience symptoms like tremors, sweating, diarrhea, thinning skin, or an increased heart rate. You may notice that you’re hungrier and eating more but that you’re losing weight. You might also have lighter than normal periods and have an increased sensitivity to heat. Finally, you could also be feeling nervous, irritable or anxious.
Although most of the symptoms of hypothyroidism and hyperthyroidism are on opposite sides of the spectrum, some that they share include exhaustion, dry and brittle hair, difficulty sleeping, muscle fatigue, and the possibility of a swollen neck caused by an enlarged thyroid gland.
Sometimes these symptoms can be slow to develop or be subtle enough to go undetected. Beta-blockers that are often prescribed to treat conditions like high blood pressure, heart problems and migraines can often mask the symptoms of hyperthyroidism, making them difficult to detect.
If left untreated, hyperthyroidism can lead to a number of complications, including heart issues like atrial fibrillation or congestive heart failure, weakened bones leading to osteoporosis, eye issues like light sensitivity, swollen eyes, or blurred vision, and red swollen skin around the legs and feet. It’s also linked to thyrotoxic crisis, a condition in which you experience a fever and your symptoms worsen, requiring immediate medical attention.
What causes hyperthyroidism?
One of the most common causes of hyperthyroidism is an autoimmune disorder known as Grave’s disease, which causes the body to create an antibody called thyroid-stimulating immunoglobulin (TSI). TSI tells the body to create an excess of thyroid hormones, throwing off your body’s delicate balance. Grave’s disease is most common among women and tends to run in families.
Another cause of hyperthyroidism is lumps in the thyroid gland known as toxic nodular or multinodular goiters, as these growths can encourage the thyroid to overproduce hormones. Viruses that cause inflammation of the thyroid, known as thyroiditis, can also cause temporary hyperthyroidism.
If you consume too much iodine through food, medication, or supplements, this can lead to the condition. It’s also not uncommon for women to develop hyperthyroidism while pregnant or shortly after giving birth.
Much like hypothyroidism, poor gut health linked to intolerances to gluten or dairy or imbalanced hormones are also thought to contribute to hyperthyroidism.
If you’re experiencing symptoms of hyperthyroidism, it’s a good idea to talk to your doctor, who may refer you to an endocrinologist who specializes in the function of glands and hormones. First, they will discuss your symptoms and your family’s history with thyroid disease. Then they will likely conduct a physical to examine you for signs like tremors in your hands, changes to your reflexes or heart rate, swelling in your thyroid gland, or any changes to your hair, skin, or eyes.
A blood test, particularly if you are older and your symptoms are less obvious, may also be used to confirm the presence of hyperthyroidism by measuring your thyroxine and thyroid-stimulating hormone levels to check for an imbalance.
Once it’s been determined that your thyroid is overactive, your doctor may conduct a radioiodine uptake test or a thyroid scan to determine what is causing your issue. A radioiodine uptake test involves taking an oral dose of radioiodine and monitoring your thyroid gland for absorption. If your thyroid absorbs high levels of the iodine, it indicates that it’s producing too much thyroxine, which would point to a root cause of Grave’s disease or thyroid nodules. If they opt for a thyroid scan, you will have a radioactive isotope injected into a vein on your hand or arm so that a camera can capture an image of your thyroid. Some doctors even combine these two tests to better determine the cause of your thyroid problem.
If you’ve been diagnosed with hyperthyroidism, the good news is that it can be controlled through various treatments that depend on your preference, condition, age, and root cause.
Anti-thyroid medications like propylthiouracil or methmimazole can be prescribed to stop your thyroid from overproducing hormones and usually start to work within six to 12 weeks. They are usually only taken for a period of around a year or so, but relapsing and having to medicate again is a possibility. Side effects can include skin rashes, fever, joint pain, or liver damage, particularly with propylthiouracil, so it is generally only prescribed when methimazole is not a suitable alternative. Beta-blockers are also sometimes prescribed to alleviate the racing heart and tremors that accompany the condition.
Oral radioactive iodine can be used to shrink the thyroid gland in just a few months. This treatment can slow your thyroid to the point of developing hypothyroidism but can be balanced out with a thyroid hormone medication. Radioactive iodine might sound scary, but it is the most common hyperthyroid treatment available and has been safely used to treat the condition for decades.
In cases where you are pregnant, or medication and radioactive iodine treatment are not suitable, surgery may be required, although it is uncommon. A thyroidectomy would remove most of your thyroid gland, requiring you to take an oral hormone replacement for the rest of your life. Thyroidectomies also come with a risk of damage to your vocal cords or other surrounding glands.
If your hyperthyroidism is caused by Grave’s disease affecting your eyes, the recommended treatment could involve a prescription for artificial tears, a corticosteroid to reduce swelling or eye surgery.
Patients who have lost a lot of muscle mass or weight prior to diagnosis should consult with their doctor on how to improve their diet and nutrition. Sometimes during treatment, patients will also find that they gain an excess amount of weight back, so moving to a well-rounded diet can be a good way to maintain a weight that’s balanced and healthy.
Since hyperthyroidism can weaken your bones, it’s important to ensure that you’re getting enough calcium and vitamin D in your diet. It’s recommended that adults get between 1000-1200 mg of calcium and 600-800 IUs of vitamin D a day depending on age. Foods that are high in calcium and vitamin D include greens, tofu, fish, and beans.
You may also want to consider cutting gluten, conventional dairy products, sugar, and packaged foods out of your diet as these substances can irritate the gut, affect your hormone balance, and trigger autoimmune responses that may in turn affect your thyroid function.
Living with a condition that affects your whole body in the way that hyperthyroidism does can be difficult, and self-care is an important coping strategy. Make sure that you get enough rest so that your body can recover and enough exercise to lower stress, maintain bone density and generally feel better. Relaxation therapies like yoga, meditation, massage, and acupuncture can also be included in your treatment regime to ensure your body and mind are at their fighting best. The better care you take of your body, the better care it can take of you.