Hyperthyroidism (Overactive Thyroid)
Definition
Hyperthyroidism is a condition in which the thyroid gland makes too much thyroid
hormone. The condition is often called overactive thyroid.
Brain-thyroid link
Alternative Names
Thyrotoxicosis; Overactive thyroid; Graves disease - hyperthyroidism; Thyroiditis -
hyperthyroidism; Toxic goiter - hyperthyroidism; Thyroid nodules - hyperthyroidism;
Thyroid hormone - hyperthyroidism
Causes
The thyroid gland is an important organ of the endocrine system. It is located at
the front of the neck just above where your collarbones meet. The gland makes the
hormones that control the way every cell in the body uses energy. This process is
called metabolism.
Thyroid gland
Many diseases and conditions can cause hyperthyroidism, including:
Graves disease (most common cause of hyperthyroidism)
Inflammation (thyroiditis) of the thyroid due to viral infections, some medicines,
or after pregnancy (common)
Taking too much thyroid hormone (common)
Noncancerous growths of the thyroid gland or pituitary gland (rare)
Some tumors of the testes or ovaries (rare)
Getting medical imaging tests with contrast dye that has iodine (rare, and only if
there is already a problem with the thyroid)
Eating too much of foods that contain iodine (very rare, and only if there is
already a problem with the thyroid)
Symptoms
Common symptoms include:
Anxiety
Difficulty concentrating
Fatigue
Frequent bowel movements
Goiter (visibly enlarged thyroid gland) or thyroid nodules
Hair loss
Hand tremor
Heat intolerance
Increased appetite
Increased sweating
Irregular menstrual periods in women
Nail changes (thickness or flaking)
Nervousness
Pounding or racing heart beat (palpitations)
Restlessness
Sleep problems
Weight loss (or weight gain, in some cases)
Goiter
Other symptoms that can occur with this condition:
Breast development in men
Clammy skin
Diarrhea
Feeling faint when you raise your hands
High blood pressure
Itchy or irritated eyes
Itchy skin
Nausea and vomiting
Protruding eyes (exophthalmos)
Skin blushing or flushing
Skin rash on the shins
Weakness of the hips and shoulders
Endocrine glands
Exams and Tests
The health care provider will do a physical exam. The exam may find the following:
High systolic blood pressure (the first number in a blood pressure reading)
Increased heart rate
Enlarged thyroid gland
Shaking of the hands
Swelling or inflammation around the eyes
Very strong reflexes
Skin, hair, and nail changes
Blood tests are also ordered to measure your thyroid hormones TSH, T3, and T4.
You may also have blood tests to check:
Cholesterol levels
Glucose
Specialized thyroid tests like Thyroid receptor antibody (TRAb) or Thyroid
Stimulating Immunoglobulin (TSI)
Imaging tests of the thyroid may also be needed, including:
Radioactive iodine uptake and scan
Thyroid ultrasound (rarely)
Treatment
Treatment depends on the cause and severity of symptoms. Hyperthyroidism is usually
treated with one or more of the following:
Antithyroid medicines (propylthiouracil or methimazole) which reduce or block the
effects of the extra thyroid hormone
Radioactive iodine to destroy the thyroid gland and stop the excess production of
hormones
Surgery to remove the thyroid
If your thyroid is removed with surgery or destroyed with radioactive iodine, you
must take thyroid hormone replacement pills for the rest of your life.
Medicines called beta-blockers may be prescribed to treat symptoms such as fast
heart rate, tremor, sweating, and anxiety until the hyperthyroidism can be
controlled.
Outlook (Prognosis)
Hyperthyroidism is treatable. Some causes may go away without treatment.
Hyperthyroidism caused by Graves disease usually gets worse over time. It has many
complications, some of which are severe and affect quality of life.
Possible Complications
Thyroid crisis (also called thyroid storm) is a sudden worsening of hyperthyroidism
symptoms that may occur with infection or stress. Fever, decreased alertness, and
abdominal pain may occur. People need to be treated in the hospital.
Other complications of hyperthyroidism include:
Heart problems such as fast heart rate, abnormal heart rhythm, and heart failure
Osteoporosis
Eye disease (double vision, ulcers of the cornea, vision loss)
Surgery-related complications, including:
Scarring of the neck
Hoarseness due to nerve damage to the voice box
Low calcium level due to damage to the parathyroid glands (located near the thyroid
gland)
Hypothyroidism (underactive thyroid)
Tobacco use may make some complications of hyperthyroidism worse.
When to Contact a Medical Professional
Contact your provider if you have symptoms of hyperthyroidism. Go to an emergency
room or call 911 or the local emergency number if you have:
Change in consciousness
Dizziness
Rapid, irregular heartbeat
Contact your provider if you are being treated for hyperthyroidism and you develop
symptoms of underactive thyroid, including:
Depression
Mental and physical sluggishness
Weight gain
References
Hollenberg A, Wiersinga WM. Hyperthyroid disorders. In: Melmed S, Auchus RJ,
Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed.
Philadelphia, PA: Elsevier; 2020:chap 12.
