Hyperthyroidism

Overactive thyroid (hyperthyroidism), which is far less common than an underactive thyroid, typically affects women over 35 and is in principle one of the well-treatable organ conditions. However, the condition requires particular behaviours that those affected should be aware of. Fortunately, we at avi are by your side at all our locations with all medical measures in the fight against hyperthyroidism.

A so-called manifest hyperthyroidism is diagnosed based on an imbalance of three hormones — specifically: a low TSH level and elevated levels of the thyroid hormones T3 and T4.

TSH, produced in the brain, is known as a "stimulating hormone" that reaches the thyroid gland via the bloodstream and prompts it to release T3 and T4.

However, if the gland produces too many of these two hormones, the body reduces the release of TSH in order to bring T3 and T4 back down.

This compensatory bodily process occasionally does lead to a genuine normalisation of T3 and T4 — but does not alter the low TSH level. In this case, manifest hyperthyroidism becomes latent hyperthyroidism.

An overactive thyroid is often a symptom of another underlying condition. The typical triggers include:

• Graves' disease (an autoimmune condition, usually genetically determined, in which the body's own antibodies bind to thyroid receptors that are normally targeted by TSH, thereby additionally stimulating thyroid hormone production)
• a benign thyroid tumour (through which thyroid cells produce hormones independently, without TSH stimulation)
• a malignant tumour
• Transient: inflammatory conditions such as de Quervain's thyroiditis or Hashimoto's thyroiditis (in these conditions, thyroid tissue is destroyed, temporarily releasing thyroid hormones)

Less commonly, hyperthyroidism is also caused by medication, for example through:

• an excessively high dose of L-thyroxine (hormone replacement for hypothyroidism)
• iodine (e.g. in iodine-containing contrast agents used in CT or X-ray imaging)
• amiodarone (an iodine-containing medication for atrial fibrillation)

Thyroid hormones act in a wide variety of organs, which is why the symptoms of hyperthyroidism are diverse. The most important include:

• a goitre of the thyroid gland (caused by excessive blood supply to the organ during increased hormone production)
• tachycardic (high-frequency) cardiac arrhythmias
• a feeling of "tightness in the chest"
• high blood pressure
• sweating
• heightened reflexes
• tremor
• hair loss
• sleep disturbances as well as restlessness and fatigue
• weight loss (due to an increased basal metabolic rate and heat production)
• muscle and bone pain
• in the presence of Graves' disease, additionally: Merseburg's triad, consisting of goitre, accelerated heartbeat, and protruding eyeballs

For our experienced doctors, the first step in treating your overactive thyroid is determining the TSH, T3, and T4 levels.

If these are consistent with hyperthyroidism, the second step is to determine its precise cause (for example, the presence of a condition such as Graves' disease) and a thyroid ultrasound is performed for confirmation.

This is followed by drug treatment of the overactive thyroid. Possible preparations include:

• antithyroid drugs (reduce hormone production)
• beta-blockers (reduce blood pressure, heart rate, tremor, and the production of T3)

Should the hyperthyroidism persist, a referral is made to radiologists or endocrinologists, who offer two treatment options. These are:

• radioiodine therapy (which destroys the overactive thyroid tissue)
• removal of the thyroid gland

For us at avi, a holistic treatment of your hyperthyroidism also includes regular monitoring and patient education.

This helps you avoid further complications such as thyrotoxic crisis, which can develop in cases of untreated or inadequately treated hyperthyroidism. This adds to the symptoms of an overactive thyroid with disorientation, fever, somnolence through to coma and renal failure.