Hyperthyroidism

"With today's treatment guidelines, hyperthyroidism is an easily controllable and curable disease".

DR. JUAN CARLOS GALOFRÉ FERRATER
SPECIALIST. THYROID DISEASE AREA

Mejor Hospital Alt

Hyperthyroidism is a group of disorders that occur with excess thyroid hormone in the body.

The most common cause is Graves Basedow disease, which is autoimmune in origin. It is the body itself that generates antibodies that stimulate the gland to synthesize more thyroid hormones.

In hyperthyroidism, the appearance of the classic symptoms, together with the appearance of goiter, creates the diagnostic suspicion that is confirmed with the determination of thyroid hormones (T4 and T3) in blood that must be elevated.

We have a specialized line in Thyroid pathology. It is integrated by doctors specialized in Endocrinology and Nutrition, Otorhinolaryngology, General Surgery and Nuclear Medicine.

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What are the symptoms of hyperthyroidism?

The symptoms are due to the acceleration of the body's functions. Excessive nervousness, insomnia, palpitations, unexplained tiredness, easy sweating, poor heat tolerance, hand tremors, weight loss despite coexisting with increased appetite and diarrhea are classic manifestations of hyperthyroidism. In women, menstrual disorders occur.

In the elderly, so-called apathetic hyperthyroidism can occur, in which the symptoms are greatly attenuated and sometimes only manifested by heart rhythm disorders.

When bulging eyes are associated the probability of Graves-Basedow disease is very high.

If the goiter reaches a large size it can produce symptoms of compression in the neck such as a feeling of pressure, difficulty swallowing food or aphonia.

<p>Imagen preview del infográfico sobre hipertiroidismo realizado por la Clínica Universidad de Navarra</p>

Learn what hyperthyroidism is and how it is treated (available in spanish)

The most common symptoms are:

  • Excessive nervousness.
  • Insomnia, palpitations.
  • Unexplained tiredness.
  • Easy sweating, bad tolerance to heat.
  • Trembling of hands.
  • Weight loss and diarrhea.

Do you have any of these symptoms?

You may have hyperthyroidism

What are the causes of hyperthyroidism?

There are different types of hyperthyroidism. Almost all are due to an excess of thyroid hormone formation. That is why, in the vast majority of them, the size of the thyroid is increased, that is, in addition to hyperthyroidism there is goiter.

The goiter is appreciated as an increase in the volume of the anterior region of the neck. The most frequent hyperthyroidism is due to diffuse goiter (Graves-Basedow disease) and nodular goiter.

In the first case, the cause is related to the presence of antibodies that stimulate the thyroid to produce great amounts of thyroid hormones, it is more frequent in young people and it can give rise to the appearance of bulging eyes (exophthalmos) and to inflammation of the front part of the legs (myxedema). This particular type is known as Graves-Basedow disease and is the most common cause of hyperthyroidism.

Nodular goiters (for an unknown reason, some area of the thyroid begins to produce a higher than normal amount of hormones) have a rough surface and hyperthyroidism in these cases occurs more often in older people.

In other cases, hyperthyroidism is due to inflammation of the gland, which can be very painful, and results in the release of thyroid hormones due to the breakdown of cells containing them. These processes are called thyroiditis and are believed to be caused by a viral infection and are usually accompanied by fever and general malaise. Taking thyroid hormone pills can also cause hyperthyroidism.

Who can suffer from hyperthyroidism?

In principle, it can occur at any age. As with other thyroid diseases, it is more common among women.

Newborn children of mothers with Graves-Basedow disease can present transitory hyperthyroidism by transplacental passage of antibodies.

What is your prognosis?

Cases of Graves-Basedow disease can have an oscillating course with temporary remissions if left untreated.

However, any type of untreated hyperthyroidism can lead to an acute situation called a thyrotoxic crisis characterized by dehydration, severe cardiac tachycardia or arrhythmia, heart failure, obnubilation and impaired consciousness.

Eventually it can be fatal and requires urgent treatment. However, with the usual treatment guidelines hyperthyroidism is an easily controllable and curable disease.

How is hyperthyroidism diagnosed?

In hyperthyroidism, the appearance of the classic symptoms, together with the appearance of goiter, creates the diagnostic suspicion that is confirmed with the determination of thyroid hormones (T4 and T3) in blood that must be elevated.

When there is suspicion of Graves Basedow disease, positive antibodies (antithyroglobulin, antimicrosomal, TSI) are observed.

A thyroid scan can help to clarify the type and function of goiter and thus to better understand the type of hyperthyroidism.

How is hyperthyroidism treated?

Once hyperthyroidism is diagnosed, drug treatment with oral antithyroids (carbimazole, methimazole, propylthiouracil), which inhibit the formation of thyroid hormones and will improve symptoms within 7-15 days, should be instituted.

In cases of Graves-Basedow disease, prolonged treatment for one or two years with antithyroid drugs, administered alone or in combination with thyroxine (to prevent hypothyroidism), may be tried.

During the treatment period, it is necessary to perform check-ups every 3-4 months in which possible side effects of antithyroid drugs should be monitored, such as skin reactions and exceptionally a decrease in white blood cells or agranulocytosis.

In the case that hyperthyroidism occurs in pregnancy, it can be treated with medications, although those that cross the fetal-placental barrier as little as possible (Propylthiouracil) should be used. In such circumstances, treatment with radioactive iodine is contraindicated.

After that period, about 40% of cases go into permanent remission, while the rest relapse. Both in this situation and in the nodular goiters that cause hyperthyroidism, it is necessary to apply a definitive treatment.

If the goiter is large, produces compressive symptoms or is accompanied by ocular alterations typical of Graves-Basedow disease, surgical treatment is indicated. It consists of removing a part of the thyroid in order to leave a smaller gland that produces less hormones.

Nowadays the results are very good, although the affectation of the recurrent nerve that gives rise to aphonia or the damage of the parathyroid glands, which produces a decrease of calcium in the blood, are possible but infrequent complications of the surgery.

If the goiter is small in size or there is a high surgical risk, a dose of radioactive iodine can be administered orally and will take effect in 1-2 months.

This option has the disadvantage of frequently causing hypothyroidism and of favoring more frequently than surgery the deterioration of the ocular alterations in Graves-Basedow disease.

Both surgery and radioactive iodine can cause hypothyroidism, which must be treated for life with thyroxine tablets. The dose adjustment is simple and in a state of compensation the condition does not imply any limitation.

Where do we treat it?

IN NAVARRE AND MADRID

The Thyroid Pathology Area
of the Clínica Universidad de Navarra

The Thyroid Pathology Area is made up of a multidisciplinary team of specialists who work together to offer patients with thyroid problems an accurate diagnosis.

After the diagnosis, the patient is indicated the most appropriate treatment for his or her case and a continuous follow-up is carried out to achieve the desired objectives.

The Clinic is a pioneer in the implementation of medical techniques in Spain and worldwide, and is an international reference in highly specialized procedures.

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