14129 Hyperthyroidism

Overview

Hyperthyroidism (also called overactive thyroid) is a condition in which your thyroid gland makes too much thyroid hormone. This hormone controls how your body uses energy, so having too much of it speeds up many of your body's functions, like your heart rate and digestion.

Hyperthyroidism is fairly common. In the UK, it is estimated that about 2 in every 100 women and 2 in every 1000 men will experience it at some point in their lives.

It can affect people of any age, but it is most often diagnosed in women between the ages of 20 and 40. It also runs in families, and people with other autoimmune conditions may be at higher risk.

Symptoms

Common symptoms

• Losing weight without trying
• A fast or irregular heartbeat
• Feeling anxious, irritable, or nervous
• Sweating more than usual and feeling hot
• Shaking or trembling hands
• Feeling tired or weak
• Frequent bowel movements
• Difficulty sleeping
• Thin skin and fine, brittle hair
• Enlarged thyroid gland (a swelling in the front of the neck)

Symptoms in children

• Difficulty gaining weight or falling behind on growth
• Trouble concentrating and poor school performance
• Feeling restless, fidgety, or easily upset
• Fast heartbeat and trouble sleeping

Symptoms in older adults

• Weight loss and muscle weakness
• Fatigue and low energy
• Heart problems, such as an irregular heartbeat or heart failure
• Sometimes depression, confusion, or reduced activity, instead of the typical symptoms like anxiety and sweating

Causes

Main causes

• Graves' disease – an autoimmune condition where your immune system mistakenly attacks the thyroid gland and makes it produce too much hormone
• Thyroid nodules – small lumps in the thyroid that can become overactive and produce extra hormone
• Thyroiditis – inflammation of the thyroid gland that can cause stored hormone to leak into the blood
• Too much iodine – from certain medicines, supplements, or dietary sources (this is rare)
• Taking too much thyroid hormone medicine (if you are already on thyroid treatment)

Risk factors

• Being female
• Having a family history of thyroid or autoimmune disease
• Having another autoimmune condition, such as type 1 diabetes or celiac disease
• Recently giving birth (postpartum thyroiditis)
• Smoking (especially if you have Graves' disease)

When to see a doctor

See a doctor urgently if:

• You have a very fast or irregular heartbeat, especially with chest pain or shortness of breath
• You feel confused, faint, or nearly pass out
• You have a high fever with sweating and a rapid pulse

Book a routine appointment if:

• You have been losing weight without trying
• You feel anxious, shaky, or hot all the time
• You notice a lump in the front of your neck
• You have persistent fatigue, weakness, or sleep problems

Diagnosis

Your doctor will ask about your symptoms, examine your neck, and check your heart rate and reflexes. They will also order blood tests to measure your thyroid hormone levels.

Tests that may be done

• Blood test for TSH (thyroid-stimulating hormone) – a low TSH usually means the thyroid is overactive
• Blood tests for T4 and T3 (thyroid hormones) – high levels confirm hyperthyroidism
• Blood tests for thyroid antibodies – to check for Graves' disease
• Thyroid ultrasound – to look for nodules or inflammation
• Radioactive iodine uptake scan – a special imaging test to show how much iodine your thyroid takes up

What to expect at your appointment

The main tests are simple blood tests that can be done at your GP surgery or a local clinic. If your results are abnormal, your doctor may refer you to a specialist (an endocrinologist) for further tests and treatment. Diagnosis usually takes a few weeks, but treatment can start once the diagnosis is confirmed.

Treatment

Treatment for hyperthyroidism aims to bring your thyroid hormone levels back to normal and relieve symptoms. The right approach depends on the cause, your age, your overall health, and your personal preferences. All treatments are effective, but each has its own benefits and risks. Your doctor will discuss what is best for you.

Self-care at home

• Take your medicines exactly as prescribed and do not stop suddenly without your doctor's advice
• Keep all follow-up appointments and blood tests
• Learn to manage stress, as stress can make symptoms worse
• Get enough rest and sleep
• Avoid caffeine and energy drinks, which can make a fast heartbeat or anxiety worse

Medical treatments

Medicines called antithyroid drugs can reduce how much thyroid hormone your thyroid makes, and they may also help with symptoms like a racing heart. Another treatment option is radioactive iodine, which is taken as a drink or capsule and destroys the overactive thyroid cells over time. In many cases, this leads to an underactive thyroid, which is then easily treated with thyroid hormone replacement. Your doctor will explain how these options work and help you weigh the pros and cons.

When is surgery considered?

Surgery to remove part or all of the thyroid gland may be recommended if there is a large goitre, if you cannot tolerate medicines, or if radioactive iodine is not suitable for you. After surgery, you will likely need lifelong thyroid hormone replacement.

Living with this condition

Living with hyperthyroidism can be challenging at first, but once your hormone levels are controlled, most people go back to a normal, active life. It may take a few weeks to months to feel fully better, and you may need regular blood tests to adjust your treatment.

Lifestyle tips

• Eat a balanced diet and try to keep your weight stable
• Avoid too much caffeine and alcohol
• Quit smoking, as smoking can worsen Graves' disease and eye problems
• Find healthy ways to manage stress, such as yoga, meditation, or talking to a friend
• Keep a symptom diary to notice patterns and share them with your doctor

Diet and exercise

There is no special diet that cures hyperthyroidism, but eating well can help you feel better. Include fruits, vegetables, lean proteins, and whole grains. If you have unintentional weight loss, try nutrient-dense foods. Regular gentle exercise, like walking or swimming, can help with energy and mood, but avoid intense workouts until your heart rate is stable.

Mental health and emotional wellbeing

Hyperthyroidism can cause anxiety, irritability, and low mood. These symptoms can be very distressing, but they often improve once your thyroid levels are treated. If you feel overwhelmed or depressed, talk to your doctor. You can also ask about counselling or other mental health support.

Prevention

Most cases of hyperthyroidism cannot be prevented because they are caused by autoimmune conditions or other factors you cannot control. However, you can help avoid complications by getting symptoms checked early and following your treatment plan closely.

Vaccines

There is no vaccine for hyperthyroidism. It is still important to keep up with recommended vaccines to protect your overall health, especially if you have a long-term condition.

Screening programmes

Routine screening is not recommended for everyone, but if you have a family history of thyroid disease or an autoimmune condition, your doctor may suggest checking your thyroid hormones with a blood test.

Complications

If left untreated

• Heart problems, including a fast or irregular heartbeat (arrhythmia), high blood pressure, and heart failure
• Bone loss and a higher risk of osteoporosis and fractures
• Thyroid storm – a rare, life-threatening sudden worsening of symptoms
• Eye problems, especially in Graves' disease, such as bulging eyes or double vision
• Pregnancy complications, such as premature birth or low birth weight

Long-term outlook

The outlook for hyperthyroidism is very good. With the right treatment, most people recover and enjoy good health. Some treatments may lead to an underactive thyroid, but that can be managed easily with daily thyroid hormone medicine. You can look forward to a full, active life with ongoing care.

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