The clinical names for an overactive thyroid gland are: hyperthyroidism (excess of thyroid) and thyrotoxicosis (poisoning by the thyroid).
The main causes of an overactive thyroid gland are:
- Graves Disease: an autoimmune disease where antibodies stimulate the thyroid cells to secrete excess thyroid hormone. This is the most common cause of an overactive thyroid (80%) and is mostly seen in women of 40-50 years of age.
- Toxic multinodular goitre (Plummer's disease): this is an enlarged thyroid gland that has lumps on it that have become overactive.
- Toxic adenoma (single, benign, non-cancerous lump).
- Thyroiditis: this is an infection or inflammation of the thyroid gland, which may temporarily cause excessive amounts of thyroid hormone. The thyroid gland will be painful and tender. It may be painful to swallow.
- Over medication of thyroxine.
- Excess iodine (from supplements and medications containing iodine, potassium iodide and betadine)
- Pituitary problems: Rarely, the pituitary produces too much TSH, which over-stimulates the thyroid.
- Very rarely, Cancer.
In overactivity T4 and T3 levels are above normal, but sometimes only the T3 level is above normal.
Thyroid illness often runs in families and can occur at any age but most often in the 40-50 age bracket. Overactivity is seen in women eight times more often than men. Because hyperthyroidism often occurs during the menopausal years, symptoms are often ignored during the early stages by both patients and doctors if you are at this age. Otherwise, it is picked up fairly quickly because of the obvious symptoms of tremor and eye problems.
It is most important to tell the doctor ALL the symptoms you experience. Being "energetic" or "tired" isn't enough for the doctor to make a proper diagnosis. Use the symptom list enclosed. Symptoms do not generally come all at once. Often one month it's one thing, the next month another. It is the doctor's job to put this all together and he can't do this if he doesn't know all of your symptoms.
SIGNS & SYMPTOMS
Eyes: Eye problems can start months before other symptoms, and carry on for a while after treatment. The whites may appear bloodshot. They may have a gritty feeling and you may have a problem with bright sunlight. The upper lids may pull upwards giving a starey appearance. The lids lag down over the eyes making the patient look extremely tired. You may have trouble focussing or have double vision. In Graves Disease, your eyes may protrude, water a lot and the upper lids may become puffy. Bags may appear under the lower lids. The eyes might ache. Without treatment, your sight is at risk. Smoking makes matters worse and it is advisable to give up.
Hair: This often becomes much thinner and appears "fly-away", with a tendency to go grey. There may be some hair loss, too. My hair came out at an alarming rate.
Neck: Your throat may be tender and feel lumpy. Swallowing can be difficult. A swelling on your neck could indicate enlargement of your thyroid gland (goitre). Because weight loss is sometimes severe, it looks as though you have a goitre but do not.
Digestive system: This happens because the metabolic rate speeds up considerably. Some people feel hungry all the time and cannot understand the weight loss because they are eating more. Fat stores are burnt off first and then body tissue if the illness is not treated. Conversely, you may lose your appetite. You may also vomit. I didn't feel hungry and could never finish the smallest of meals but I craved chocolate in the evenings. In six months I lost 2 stone. You may become very thirsty and pass a lot of urine.
Heart: Because the increase in thyroid hormones speed up metabolism, the heart heats faster. You might notice a "butterfly" feeling in your chest. Your heart may beat very fast in either a regular or irregular rhythm (palpitations). Sometimes your heart may beat so fast you will feel faint. You may also have low blood pressure.
Shortness of Breath: This is noticed after climbing stairs, carrying heavy objects or sometimes even walking. It can happen when you experience palpitations.
Bowel: You may need to go to the toilet more often but the stools are normally formed. The stools may be pale because extra fat is being rushed through the system. Some people have diarrhoea.
Skin: The skin may become thin, soft, warm, damp and may flush easily. You may also itch. Spidery veins may appear on your cheeks. Your hands may seem red and sweaty. People with Graves Disease sometimes develop patches on their lower legs that are reddened and thickened, and the hair on the legs may be courser. Patches may also appear on the foot or the big toe. You may also bruise more easily because the number of your platelets is reduced.
Nails: Nails appear thick and flaky. They may become loose at the nail bed, where dirt collects and the tips may rise up. The fingertips may also swell.
Bones: On-going over activity of the thyroid gland over a long period may cause osteoporosis, which may produce aches and pains, especially in the back.
Muscles: Too much thyroid hormone can speed up the breakdown of muscle fibres quicker than they can be replaced. You may feel weakness all over your body especially in the shoulders, upper arms and thighs. If you have a frozen shoulder, this could indicate hyperthyroidism. Your hands may be swollen and painful too. The doctor may find that you have brisk reflexes.
Temperature: Metabolism increases and therefore our bodies produce excessive heat, which results in constant sweating, particularly at night which, again, is often put down to the menopause. I walked around in T-shirts and shorts in the middle of December, with the windows open and the central heating switched off!
Oedema (Swelling): Your ankles may swell. Mine were like melons and I could not get shoes on. I was prescribed frusemide, a diuretic drug used for water retention.
Mood: Patients find themselves unable to cope with life's demands, lose their temper frequently and burst into tears for no reason. They may feel nervous, anxious and irritable, although some people feel apathetic. You may feel tired but be unable to sleep. Concentration becomes difficult. You may have racing thoughts and be very talkative. You may have mood swings. Anti-depressants are often prescribed.
Sex: You may have an increased sex drive. Decreased libido is also seen.
Menstruation: Your periods may be lighter than normal or even stop altogether. Regular periods may become irregular.
Fertility: Fertility is reduced in both men and women. If you do conceive, there is an increased risk of miscarriage.
Tremor and Shakiness: This generally occurs in the hands. It may be difficult to hold a cup and saucer. The tremor is obvious with outstretched hands. You may feel an inner tremor too.
Overactive/Tiredness: Many people have surges of energy and can't sit still for a minute. Some people are not talkative, nervous and full of unnatural energy. They have to stay in bed because the huge amount of thyroid hormones has made them feel exhausted and unable to move. It's as though the body is in a crisis - and it is!
Men: A classic sign of hyperthyroidism in men is breast enlargement.
THE ADRENAL CONNECTION
Because our hormones are all inter-connected, it is sensible to ensure that the adrenal glands are working properly and we do not have Low Adrenal Reserve because the symptoms are very similar to hyperthyroidism.
TESTS
A simple blood test should reveal whether your thyroid gland is overactive, although as we have said before blood tests are not totally reliable.
If the test comes back positive, the GP will make a decision as to treatment depending on your age, sex, and size of goitre. You may be sent for an Iodine Uptake Scan: (Do not confuse with Radio Active Iodine 131 treatment). This scan will show if some parts of the thyroid gland are greedier for iodine than other parts. If the thyroid is producing too much hormone, your uptake (absorption) will be high. If your uptake is low it means that your hyperthyroidism is caused by either too much thyroid hormone or an inflammation of the thyroid. The scan can show up hot spots or even a single over active nodule. |
