(Graves Disease; Overactive Thyroid)
The thyroid gland is a butterfly-shaped gland in the front of the neck. It produces hormones that control metabolism. Hyperthyroidism is the overproduction of thyroid hormone by the thyroid gland.
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Hyperthyroidism may be caused by:
- Graves disease—an autoimmune disorder that occurs when the immune system produces antibodies that attack cells of the thyroid gland
- Toxic uninodular goiter—a single area/nodule in the thyroid gland is overactive
- Toxic multinodular goiter—multiple nodules in the thyroid gland which overproduce thyroid hormone
- Thyroiditis—inflammation of the thyroid that may later lead to hypothyroidism
- Taking too much thyroid hormone—very rarely from meat sources contaminated by animal thyroid glands
Factors that may increase your chances of hyperthyroidism:
- Pregnancy—postpartum thyroiditis (hyperthyroidism followed by hypothyroidism)
- Family history of Graves disease
- Certain viral infections
Symptoms come on slowly. As the thyroid becomes more overactive, symptoms may appear. Examples include:
- Heart palpitations—more common in people over 50 years old
- Rapid or irregular pulse
- Shortness of breath
- Heat intolerance
- Nervousness, restlessness, or irritability
- Difficulty sleeping
- Increased number of bowel movements/diarrhea
- Irregular or absence of menstrual periods
- Unexplained weight loss despite an increased appetite
- Increased sweating
- Double vision
- Lumpy, red thickening of the skin in front of the shins
You will be asked about your symptoms and medical history. A physical exam will be done.
Tests may include:
- Blood tests to measure level of thyroid hormones and look for thyroid antibodies
- Radioactive iodine uptake test to measure how much iodine the thyroid gland absorbs over the course of several hours
Treatment will depend what is causing the hyperthyroidism. It will also be adjusted if you are pregnant. Talk to your doctor about the best treatment options for you.
Antithyroid medicine will reduce thyroid activity. Smoking can interfere with some of the medications. If you smoke, talk to your doctor about how you can successfully quit.
All theses medications can cause a rash, fever and painful joints. Serious adverse reactions include increased risk of infection and liver damage.
If the disease goes into remission, you may no longer need medication.
This type of medication can relieve rapid heart rate and nervousness.
Radioactive iodine is taken orally. It is then absorbed by the thyroid gland. Once there, it damages most of the thyroid cells. These cells can no longer produce thyroid hormones. Within days, the excess iodine passes out of the body in the urine or changes into a nonradioactive state. This treatment reduces the activity of the thyroid. Sometimes the treatment can decrease the thyroid levels too much. In this case, you will need to take a daily thyroid hormone replacement.
Thyroidectomy is uncommon for the treatment of hyperthyroidism. It will remove part or all of the thyroid. It may be an option when medical therapy fails.
After a thyroidectomy, you may need to take daily thyroid, calcium, or vitamin D supplements.
If there are eye symptoms like dry red eyes or double vision, your doctor may prescribe:
- Eye protection before sleep
- Artificial tears
You may be referred to an eye specialist.
There are no current guidelines to prevent hyperthyroidism.
American Thyroid Association
Graves' Disease & Thyroid Foundation
Thyroid Foundation of Canada
Hyperthyroidism and thyrotoxicosis. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116479/Hyperthyroidism-and-thyrotoxicosis. Updated July 27, 2017. Accessed December 15, 2017.
Shomon M. Frequently asked questions on Graves disease & hyperthyroidism. Thyroid-Info website. Available at: http://www.thyroid-info.com/articles/hyperthyroidism-faq.htm. Accessed December 15, 2017.
Van Geest RJ, Sa sim IV, Koppeschaar HP, et al. Methylprednisolone pulse therapy for patients with moderately severe Graves orbitopathy: a prospective, randomized, placebo-controlled study. Eur J Endocrinol. 2008;158(3):229-237.
1/30/2009 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T115280/Graves-disease-in-adults: Nyirenda MJ, Taylor PN, Stoddart M, Beckett GJ, Toft AD. Thyroid-stimulating hormone-receptor antibody and thyroid hormone concentrations in smokers vs nonsmokers with Graves disease treated with carbimazole. JAMA. 2009;301(2):162-164.
6/10/2014 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T900418/Thyroid-surgery-considerations: Alhefdhi A, Mazeh H, Chen H. Role of postoperative vitamin D and/or calcium routine supplementation in preventing hypocalcemia after thyroidectomy: a systematic review and meta-analysis. Oncologist. 2013;18(5):553-542.
Last reviewed November 2018 by EBSCO Medical Review Board Marcie L. Sidman, MD Last Updated: 8/16/2019