Hyperthyroidism
"With today's treatment guidelines, hyperthyroidism is an easily controllable and curable disease".
DR. JUAN CARLOS GALOFRÉ FERRATER
SPECIALIST. THYROID DISEASE AREA
What is hyperthyroidism
Hyperthyroidism is a condition that occurs when the thyroid gland, located in the neck, works harder than normal and produces excess thyroid hormones.
These hormones are key to regulating the body's metabolism, and excess thyroid hormones can cause symptoms such as nervousness, weight loss or increased heart rate.
The most common cause of this condition is Graves-Basedow disease. This is an autoimmune problem: the body's own defence system generates antibodies that confuse the thyroid gland and stimulate it to produce more hormones than necessary.
In hyperthyroidism, the appearance of the classic symptoms together with the appearance of goitre (irregular growth of the thyroid gland), creates the diagnostic suspicion which is confirmed with the determination of thyroid hormones (T4 and T3) in the blood, which should be elevated.
At the Clínica Universidad de Navarra we have a Thyroid Pathology Department. It is made up of doctors specialising in Endocrinology and Nutrition, Otorhinolaryngology, General Surgery and Nuclear Medicine.
Symptoms of hyperthyroidism
The symptoms are due to the acceleration of the body's functions. The most common symptoms are
- Excessive nervousness
- Insomnia
- Palpitations
- Unexplained tiredness
- Easy sweating, poor heat tolerance
- Hand trembling
- Weight loss and diarrhoea
In women, menstrual disturbances may occur. In elderly people, so-called apathetic hyperthyroidism may occur, in which the symptoms are very attenuated.
When the patient also has bulging eyes, the likelihood of Graves-Basedow disease is very high. On the other hand, if the goitre reaches a large size, it may produce symptoms of neck compression.
Do you have any of these symptoms?
If you suspect that you have any of the above symptoms,
you should consult a medical specialist for a diagnosis.
What are the causes of hyperthyroidism?
There are different types of hyperthyroidism. Almost all of them are due to an excess of thyroid hormones. This is why, in the vast majority of cases, the size of the thyroid is increased, i.e. in addition to hyperthyroidism, there is a goitre.
- Diffuse goitre. In this case, the cause is related to the presence of thyroid-stimulating antibodies which, in addition to stimulating the thyroid to produce large amounts of thyroid hormones, is more common in young people and can lead to bulging eyes (exophthalmos) and swelling of the front of the legs (myxedema). This particular type is known as Graves-Basedow disease and is the most common cause of hyperthyroidism.
- Nodular goitres (for an unknown reason, some area of the thyroid begins to produce a higher than normal amount of hormones) have a rough surface and hyperthyroidism in these cases occurs more frequently in older people.
- Thyroiditis. In other cases hyperthyroidism is due to inflammation of the gland, which can be very painful, and results in the release of thyroid hormones due to rupture of the cells that contain them. These processes are called thyroiditis, are thought to be caused by a viral infection and are often accompanied by fever and general malaise. Taking thyroid hormone pills can also cause hyperthyroidism.
What is the diagnosis of hyperthyroidism?
In hyperthyroidism, classical symptoms and goitre suggest the diagnosis, confirmed by elevated T4 and T3 blood levels. In Graves-Basedow disease, antibodies (anti-thyroglobulin, anti-microsomal, TSI) are usually positive. Thyroid scintigraphy helps to determine the type and function of the goitre and to classify hyperthyroidism.
Without treatment, hyperthyroidism can progress to thyrotoxic crisis, an emergency characterised by dehydration, severe tachycardia, heart failure and altered consciousness, which can be fatal. However, with regular treatment, it is a manageable and curable disease.
Who can suffer from hyperthyroidism
The disease can manifest itself at any stage of life. As with most thyroid-related conditions, it is more prevalent in women.
Newbornsborn to mothers with Graves-Basedow disease may develop transient hyperthyroidism.
This occurs due to the transplacental passage of thyroid-stimulating antibodies from the mother to the foetus during pregnancy. This condition is usually temporary, but requires careful monitoring and appropriate treatment to avoid complications in the newborn.
How is hyperthyroidism treated?
Conservative treatment of hyperthyroidism
Once hyperthyroidism is diagnosed, drug treatment with oral antithyroids (carbimazole, methimazole, propylthiouracil), which inhibit the formation of thyroid hormones and will improve symptoms within 7-15 days, should be instituted.
In cases of Graves-Basedow disease, prolonged treatment for one or two years with antithyroid drugs, administered alone or in combination with thyroxine (to prevent hypothyroidism), may be tried.
During the treatment period, it is necessary to perform check-ups every 3-4 months in which possible side effects of antithyroid drugs should be monitored, such as skin reactions and exceptionally a decrease in white blood cells or agranulocytosis.
In the case that hyperthyroidism occurs in pregnancy, it can be treated with medications, although those that cross the fetal-placental barrier as little as possible (Propylthiouracil) should be used. In such circumstances, treatment with radioactive iodine is contraindicated.
Surgery for hyperthyroidism
After that period, about 40% of cases go into permanent remission, while the rest relapse. Both in this situation and in the nodular goiters that cause hyperthyroidism, it is necessary to apply a definitive treatment.
If the goiter is large, produces compressive symptoms or is accompanied by ocular alterations typical of Graves-Basedow disease, surgical treatment is indicated. It consists of removing a part of the thyroid in order to leave a smaller gland that produces less hormones.
Nowadays the results are very good, although the affectation of the recurrent nerve that gives rise to aphonia or the damage of the parathyroid glands, which produces a decrease of calcium in the blood, are possible but infrequent complications of the surgery.
Radioactive iodine treatment
If the goiter is small in size or there is a high surgical risk, a dose of radioactive iodine can be administered orally and will take effect in 1-2 months.
This option has the disadvantage of frequently causing hypothyroidism and of favoring more frequently than surgery the deterioration of the ocular alterations in Graves-Basedow disease.
Both surgery and radioactive iodine can cause hypothyroidism, which must be treated for life with thyroxine tablets. The dose adjustment is simple and in a state of compensation the condition does not imply any limitation.
Where do we treat it?
IN NAVARRA AND MADRID
The Thyroid Pathology Area
of the Clínica Universidad de Navarra
The Thyroid Pathology Area is made up of a multidisciplinary team of specialists who work together to offer patients with thyroid problems an accurate diagnosis.
After the diagnosis, the patient is indicated the most appropriate treatment for his or her case and a continuous follow-up is carried out to achieve the desired objectives.
The Clinic is a pioneer in the implementation of medical techniques in Spain and worldwide, and is an international reference in highly specialized procedures.
What diseases do we treat?
Why at the Clinica?
- Prestigious professionals who are a national reference.
- In 24-48 hours we make the diagnosis and we can start the most appropriate treatment for each patient.
Our team of experts in hyperthyroidism
