Dear Alice,

I saw that you've answered a question about hypothyroidism in the past, but I was wondering if you could talk a bit about hyperthyroidism as well. Two years ago, my doctor suspected (through blood tests) that I might be hyperthyroid, but nothing was done because my symptoms were mild and a second round of tests came back normal. Lately, I've been noticing things that I've heard are symptoms of hyperthyroidism (e.g., anxiety, irritability, increased bowel movements, etc.), and I am not sure what to do about it. Does hyperthyroidism require treatment and should I be worried about thyroid cancer?

Dear Reader,

To quickly answer your question: yes, in the event of a diagnosis of hyperthyroidism, treatment is required to prevent complications. Now, to dig a bit deeper into your line of questioning...

It’s great that you’ve been keeping tabs on how you’re feeling. In terms of thyroid cancer, while previous research indicated that thyroid cancer rarely accompanied hyperthyroidism, newer studies imply that there may be higher rates of thyroid cancer in people with hyperthyroidism. All that said, the changes you've noticed certainly warrant further investigation and it's best done with the help of a health care provider. Revisiting whether these symptoms may help you determine if you're dealing with hyperthyroidism and what, if any, risk you might have for thyroid cancer.

First, a primer on hyperthyroidism. Also referred to as overactive thyroid, this condition results in an acceleration of your body’s metabolism, causing sudden weight loss, nervousness, irritability, and irregular or rapid heartbeat. There are several causes of this condition, but the end result is that an overactive thyroid causes your body to produce too much thyroid hormone. Other symptoms can include increased appetite, sweating, anxiety, and tremors. Interestingly (and for unknown reasons), in elderly people, hyperthyroidism may make them feel depressed, confused, and lethargic. Some people may develop a goiter, a nodular-like swelling at the front of the neck near the chest. The most common form of hyperthyroidism is called Graves’ disease, an autoimmune condition which is caused by the body’s immune system attacking the thyroid gland. This is what causes the increased hormone production.

You mentioned that during your last visit, your health care provider did not recommend treatment because of the mild symptoms and blood tests coming back normal the second time. S/he may have determined that treatment was not necessary if you were mildly symptomatic a few years ago. This is likely because there is still disagreement in the field about how best to address “subclinical hyperthyroidism,” or people with mild symptoms and normal or close-to-normal lab results. At your next visit, make sure that your provider is aware of the symptoms you've been experiencing. This being said, if you feel as if s/he seems isn't taking your concerns seriously, you could consider getting a second opinion. Knowing whether your symptoms are a result of hyperthyroidism or some other condition is crucial to your future health. If left untreated, hyperthyroidism can lead to significant complications, such as:

  • Eye problems that can result in vision loss
  • Heart problems, such as atrial fibrillation and congestive heart failure
  • Osteoporosis (postmenopausal women are at higher risk)
  • Thyrotoxic crisis (a rare, life-threatening, and sudden intensification of your symptoms, including a high fever)

The good news is that there are a number of therapies for hyperthyroidism and many clinicians suggest using more than one treatment. Radioactive iodine can be used to reduce the amount of thyroid hormone made by the gland. It is safe, effective, and is administered in just a single dose, usually orally in liquid or capsule form. For most people, there are few side effects. Though less popular, antithyroid medications are sometimes used, especially in such cases where radioactive iodine therapy is not recommended (e.g., during pregnancy). This type of medication is also usually taken orally, though it can be absorbed into the skin as a cream. Usually, antithyroid medications have to be taken at least twice daily. They gradually reduce the amount of thyroid hormone in the body over a two to eight month period. The oldest treatment, surgery, removes all or part of the thyroid gland. While often effective, this treatment is usually for people with a goiter, who are at risk of having thyroid cancer, who refuse or are unable to complete iodine therapy, or do not respond to the other, less invasive treatments. Lastly, many people with this condition will also take a beta-blocker, a medication that helps slow the heart and protect it from overstimulation by high thyroid hormone levels. If this overview of treatment options seems daunting, try not to stress! Upon diagnosis, a health care provider or endocrinologist can help you figure out what therapies might be best for you. S/he may also take a small biopsy of your thyroid to assess your risk for cancer.

The bottom line here is that when it comes to your health, you can often be your own best advocate. Kudos to you for noticing changes in your body and seeking out more information to take charge of your own health.

Well wishes to you!

Alice!

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