Hyperthyroidism

Hyperthyroidism is an overactive thyroid gland producing too much hormone, which speeds up the heart and metabolism. It is frequently mistaken for anxiety or a heart problem before the thyroid is tested.

Symptoms

Not everyone gets every symptom, and the pattern can differ in older people, in people with diabetes and in children. These are the ones most often reported.

• Weight loss despite a good or increased appetite
• Palpitations and a fast pulse
• Excessive sweating and intolerance of heat
• Tremor of the outstretched hands
• Irritability, restlessness and difficulty sleeping
• Loose stools and irregular or scanty periods
• Prominent or gritty eyes in some patients

When to see a doctor

• Palpitations with weight loss and heat intolerance
• An irregular pulse, especially in an adult over 50
• High fever, agitation, vomiting and a very fast heart rate — attend the emergency department
• Increasing eye prominence, double vision or eye pain

Tests that may be advised

Your consultant will order only the investigations that change the plan. Most of the following are available on the SIMS campus, so results usually come back the same visit.

• TSH, free T3 and free T4
• Thyroid antibody testing
• ECG to check for atrial fibrillation
• Ultrasound of the thyroid, and a radionuclide scan where indicated
• Complete blood count and liver function before starting anti-thyroid treatment

How it is treated

Treatment is decided case by case — by how advanced the problem is, what else you are being treated for, and what you can realistically sustain. Broadly, it involves the following.

• Anti-thyroid medication with regular blood count and liver monitoring
• Medication to control heart rate and tremor while the thyroid settles
• Radioiodine therapy referral in suitable patients
• Surgery for a large goitre, pressure symptoms or when other treatments are unsuitable
• Long-term follow-up, as hypothyroidism can develop after treatment