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Hyperthyroidism

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Hyperthyroidism is an endocrine disease involving the thyroid gland. This small gland sits in the neck and produces thyroid hormones. These hormones are vital for the normal function of cells. In hyperthyroidism, the gland produces excessive amounts of these hormones. This state can lead to thyrotoxicosis, which is the condition of having elevated hormone levels. While some people use these terms interchangeably, they describe slightly different things. Hyperthyroidism specifically refers to the overproduction by the gland itself.

Blausen 0534 Goiter
Blausen 0534 Goiter

Excess thyroid hormone affects the entire body by overstimulating metabolism. It also disrupts the sympathetic nervous system. This disruption causes various body systems to speed up. The resulting symptoms often resemble an overdose of epinephrine, which is also known as adrenaline. This can cause a fast heartbeat or palpitations. It can also lead to hand tremors and anxiety. The digestive system may experience hypermotility, which often results in diarrhea. Many people also experience unintended weight loss despite having a good appetite.

Causes of hyperthyroidism
Causes of hyperthyroidism

There are several distinct causes for this condition. Graves' disease is the most common cause. It accounts for about 50% to 80% of cases in the United States. This is an autoimmune disease. Other causes include a multinodular goiter or a toxic adenoma. A toxic adenoma is a single nodule that secretes excess hormone. Inflammation of the thyroid, called thyroiditis, can also cause it. Some people may consume too much iodine or synthetic thyroid hormone. A rare cause is a pituitary adenoma, which is a growth on the pituitary gland.

Causes of hyperthyroidism
Causes of hyperthyroidism

Doctors use specific tests to diagnose hyperthyroidism and find its cause. They often start with blood tests to check hormone levels. Typically, these tests show a low thyroid stimulating hormone, or TSH. TSH is the signal from the brain that tells the thyroid to work. If the thyroid is overactive, the TSH levels drop. Doctors may also use radioiodine uptake tests or a thyroid scan. They can also measure antithyroid autoantibodies. Finding positive thyroidal thyrotropin receptor antibodies can confirm a diagnosis of Graves' disease.

Proptosis and lid retraction from Graves' Disease
Proptosis and lid retraction from Graves' Disease

Treatment depends on the cause and the severity of the disease. There are three main medical options. The first is radioiodine therapy. A patient takes iodine-131 by mouth. This iodine concentrates in the thyroid and destroys it over weeks or months. The resulting hypothyroidism is then treated with synthetic hormone. The second option is medication. Beta blockers can help control symptoms like a fast heart rate. Anti-thyroid medications, such as methimazole, can temporarily help. The third option is thyroid surgery to remove the gland.

Blausen 0534 Goiter
Blausen 0534 Goiter

Hyperthyroidism affects a specific portion of the global population. In the United States, it affects about 1.2% of people. Worldwide, it affects 2.5% of adults. The condition occurs two to ten times more often in women. Most people experience the onset between 20 and 50 years of age. However, the disease is more common in those over 60 years old. Some patients may face a life-threatening complication called a thyroid storm. This is a medical emergency where symptoms like confusion and high temperature worsen. The mortality rate for a thyroid storm is between 3.6% and 17%.

Proptosis and lid retraction from Graves' Disease
Proptosis and lid retraction from Graves' Disease

Long-term effects can impact different body systems. Untreated hyperthyroidism can lead to osteoporosis, which is bone loss. This occurs in 10% to 20% of patients due to increased bone remodeling. In Graves' disease, a specific sign called ophthalmopathy can occur. This causes the eye muscles to swell and push the eyes forward. This protrusion is called exophthalmos. Other ocular signs include eyelid retraction, known as the Dalrymple sign. There is also lid-lag, or von Graefe's sign, where the eyelid fails to follow the iris downward.

Proptosis and lid retraction from Graves' Disease
Proptosis and lid retraction from Graves' Disease
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