Hyperthyroidism: What are the warning signs?
Written in association with:An overactive thyroid can cause a wide range of symptoms that people often do not realise are connected to excessive hormone production. In this informative article, leading consultant physician in diabetes, endocrinology and internal medicine Professor Franklin Joseph offers expert insight on the most common signs and symptoms of hyperthyroidism. He also sheds light on the different causes behind the condition and how an overactive thyroid is treated.
What are the signs and symptoms of hyperthyroidism?
The signs and symptoms of hyperthyroidism, or an overactive thyroid, can come on slowly or quickly depending on how aggressive the over activity is. The most common symptoms that people experience include:
- an intolerance to heat and feeling warmer than usual
- excessive sweating
- increased irritability and anxiety
- palpitations
- feeling short-tempered, agitated or emotional
- unintended weight loss
- increased frequency of bowel movements
- irregular periods or a complete lack of periods, known as amenorrhea
- shaking or trembling in the hands
Fatigue is also a common symptom of both an underactive and overactive thyroid. Those who wear a Fitbit or an Apple watch may also notice that their heart rate is a lot faster than usual. Depending on the cause of the hyperthyroidism, patients sometimes experience changes in the eyes, which is related to something called thyroid eye disease. This can cause double vision, gritty or dry eyes or more prominent eyes. Some patients also notice discomfort or swelling in the neck, which is caused by the thyroid gland itself that may have become enlarged. This can happen because of inflammation or what we call nodule formation, which is the growth of benign (non-cancerous) lumps within the thyroid gland.
Put simply, the thyroid hormone is the hormone of metabolism. If you have too much of this hormone, your metabolism and everything in your body just goes faster and at fuller steam than it should. As a result, some people also experience insomnia or their sleep pattern is interrupted.
What are the causes behind hyperthyroidism?
There are a number of different ways in which the thyroid can become overactive. In many cases, a condition called Graves’ disease, or Graves’ thyrotoxicosis, is the cause behind an overactive thyroid. Graves’ disease runs in families and gives people a genetic predisposition to make more antibodies than are necessary. Antibodies are chemicals or proteins within our body that normally fight off external things like viruses as part of our internal defence system. In patients with autoimmune conditions, such as Graves’ disease, the body mistakenly attacks itself which can lead to some abnormal functioning and health problems. In this case, the excessive antibodies in patients with Graves’ disease stimulate the thyroid to make excessive hormones and to work overtime.
Another cause of an overactive thyroid can be a toxic multinodular goitre. This occurs when there is a benign overgrowth of multiple nodules or little lumpy sacks of fluid filled cysts that occur within the thyroid. These growths develop slowly over time, gradually building up until there are multiple little pockets called nodules. And once several nodules have developed, this becomes a multinodular goitre (goitre being a term to represent an enlarged thyroid gland). These nodules act like little factories that make extra hormones. When this becomes excessive, the patient begins to experience the unpleasant symptoms associated with hyperthyroidism.
In other cases, a single adenoma can also cause hyperthyroidism. This is one single lumpy area or toxic growth within the thyroid that starts to make extra hormones. Occasionally, short-term over activity of the thyroid can occur when it becomes inflamed. This is short-lived as the thyroid hormone that is within the gland is released into the system but things do eventually settle down. There are also some medications that can cause the thyroid to become overactive, commonly Amiodarone, which is used for treating irregular heart rhythms.
Is it possible to monitor thyroid health at home?
Monitoring your thyroid health at home, whether you have been diagnosed with a thyroid problem or not, is quite tricky. The most important thing is to have a good awareness of the symptoms so that if you observe any of them, you can request a blood test. There is a specific blood test to look at thyroid stimulating hormone (TSH) levels. In a patient with hyperthyroidism, TSH is usually suppressed and so this is one way to make the diagnosis.
I would really encourage people to look out for hyperthyroidism symptoms and to seek help promptly should they occur. Interestingly, blood tests are becoming more and more available to people and in some cases, people order a thyroid test and then seek help after that. The important thing is that the patient gets appropriate support from a medical professional and undergoes the right biochemical tests so a diagnosis can be made.
In terms of people who have been diagnosed with thyroid problems, monitoring should take place on a regular basis, usually by a blood test every six to twelve months. Those with a family history of thyroid dysfunction may wish to undergo yearly blood tests to screen for irregularities even if they don’t observe any symptoms, although this is not usually offered through the NHS.
How can the symptoms of hyperthyroidism be treated?
Hyperthyroidism is treated in a number of different ways. Once a diagnosis has been confirmed, if the patient has is experiencing palpitations, tremors or anxiety, the first thing we do is prescribe beta blocker tablets to resolve this. Beta blockers are a group of tablets that we use to treat heart disease, blood pressure and also anxiety. In this case, they help to block the effects of the extra thyroid hormone on the heart and the sympathetic nervous system, which controls sweating and tremors.
This immediately calms the patient and helps to take the edge off the severity of the symptoms. However, beta blocker tablets don't actually affect the overproduction of the hormones, so further treatment is required. To suppress or interfere with the production of the extra thyroid hormone, we use anti thyroid medications. In the UK, the two common ones that we use are Carbimazole and Propylthiouracil which are taken in tablet form either once or a few times every a day.
Over a period of days to weeks, these medications will gradually bring the production of the extra hormone down to be within the normal range. Once those levels of hormone are brought under control, beta blockers are no longer required. Most patients follow this treatment for a period of between twelve to eighteen months, although this often depends on the cause behind an individual’s hyperthyroidism. The vast majority of patients start off their treatment with medication in the form of tablets but depending on the individual circumstances, sometimes alternative options may be preferable, including radioactive iodine treatment or surgery. These options provide a more permanent solution to the problem and should be discussed thoroughly with your practitioner.
What lifestyle changes can help to relieve symptoms?
Once the medication has started to have an effect, this should help to keep the symptoms under control. Until things are under control, I would suggest avoiding stressful situations wherever possible as patients with an overactive thyroid are prone to anxiety.
Secondly, because the heart rate is often accelerated in patients with hyperthyroidism, excessive high-intensity cardiovascular exercise can cause the heart to race too quickly, making them feel very uncomfortable or faint. Therefore strenuous exercise is best avoided until things have calmed down.
I would also advise patients to watch their diet carefully during this time. Although some people lose weight when the thyroid hormone is excessive, this doesn’t apply to all patients. As treatment starts to effect the overactive thyroid, sometimes patients regain any lost weight quite quickly and may even put on additional weight due to the readjustments that are occurring within the body. Therefore, it’s important to ensure that you're eating enough nutritious food with a good management of calories, protein and carbohydrates to help preserve your muscle mass and your health.
A lot of patients experience heat intolerance, so keeping cool and avoiding excessively hot weather or taking careful control of the temperature where possible is advised. However, these are steps you will likely take intuitively because of the way you feel.
If you are concerned about symptoms of hyperthyroidism and wish to book a consultation with Professor Joseph, you can do so by visiting his Top Doctors profile.
