Hyperthyroidism is diagnosed using:
- Medical history and physical exam. During the exam your doctor may try to detect a slight tremor in your fingers when they're extended, overactive reflexes, eye changes and warm, moist skin. Your doctor will also examine your thyroid gland as you swallow to see if it's enlarged, bumpy or tender and check your pulse to see if it's rapid.
- Blood tests. A diagnosis can be confirmed with blood tests that measure the levels of thyroxine and TSH in your blood. High levels of thyroxine and low or nonexistent amounts of TSH indicate an overactive thyroid. The amount of TSH is important because it's the hormone that signals your thyroid gland to produce more thyroxine. These tests are particularly necessary for older adults, who may not have classic symptoms of hyperthyroidism.
If blood tests indicate hyperthyroidism, your doctor may recommend one of the following tests to help determine why your thyroid is overactive:
Radio iodine uptake test. For this test, you take a small, oral dose of radioactive iodine (radioiodine). Over time, the iodine collects in your thyroid gland because your thyroid uses iodine to manufacture hormones. You'll be checked after two, six or 24 hours — and sometimes after all three time periods — to determine how much iodine your thyroid gland has absorbed.
A high uptake of radioiodine indicates your thyroid gland is producing too much thyroxine. The most likely cause is either Graves' disease or hyperfunctioning nodules. If you have hyperthyroidism and your radioiodine uptake is low, this indicates that the thyroxine stored in the gland is leaking into the bloodstream and indicates you may have thyroiditis.
Knowing what's causing your hyperthyroidism can help your doctor plan the appropriate treatment. A radioactive iodine uptake test isn't uncomfortable, but it does expose you to a small amount of radiation.
Thyroid scan. During this test, you'll have a radioactive isotope injected into the vein on the inside of your elbow or sometimes into a vein in your hand. You then lie on a table with your head stretched backward while a special camera produces an image of your thyroid gland on a computer screen.
The time needed for the procedure may vary, depending on how long it takes the isotope to reach your thyroid gland. You may have some neck discomfort with this test, and you'll be exposed to a small amount of radiation.
Sometimes you may have a thyroid scan as part of a radioactive iodine uptake test. In that case, the orally administered radioactive iodine is used to image your thyroid gland.
Several treatments for hyperthyroidism exist. The best approach for you depends on your age, physical condition, the underlying cause of the hyperthyroidism, personal preference and the severity of your disorder:
- Radioactive iodine. Taken by mouth, radioactive iodine is absorbed by your thyroid gland, where it causes the gland to shrink and symptoms to subside, usually within three to six months. Because this treatment causes thyroid activity to slow considerably, causing the thyroid gland to be underactive (hypothyroidism), you may eventually need to take medication every day to replace thyroxine. Used for more than 60 years to treat hyperthyroidism, radioactive iodine has been shown to be generally safe.
- Anti-thyroid medications. These medications gradually reduce symptoms of hyperthyroidism by preventing your thyroid gland from producing excess amounts of hormones. They include propylthiouracil and methimazole (Tapazole). Symptoms usually begin to improve in six to 12 weeks, but treatment with anti-thyroid medications typically continues at least a year and often longer. For some people, this clears up the problem permanently, but other people may experience a relapse. Both drugs can cause serious liver damage, sometimes leading to death. Because propylthiouracil has caused far more cases of liver damage, it generally should be used only when you can't tolerate methimazole. A small number of people who are allergic to these drugs may develop skin rashes, hives, fever or joint pain. They also can make you more susceptible to infection.
- Beta blockers. These drugs are commonly used to treat high blood pressure. They won't reduce your thyroid levels, but they can reduce a rapid heart rate and help prevent palpitations. For that reason, your doctor may prescribe them to help you feel better until your thyroid levels are closer to normal. Side effects may include fatigue, headache, upset stomach, constipation, diarrhea or dizziness.
Surgery (thyroidectomy). If you're pregnant or otherwise can't tolerate anti-thyroid drugs and don't want to or can't have radioactive iodine therapy, you may be a candidate for thyroid surgery, although this is an option in only a few cases.
In a thyroidectomy, your doctor removes most of your thyroid gland. Risks of this surgery include damage to your vocal cords and parathyroid glands — four tiny glands situated on the back of your thyroid gland that help control the level of calcium in your blood. In addition, you'll need lifelong treatment with levothyroxine (Levoxyl, Synthroid, others) to supply your body with normal amounts of thyroid hormone. If your parathyroid glands also are removed, you'll need medication to keep your blood-calcium levels normal.
If Graves' disease affects your eyes (Graves' ophthalmopathy), you can manage mild signs and symptoms by avoiding wind and bright lights and using artificial tears and lubricating gels. If your symptoms are more severe, your doctor may recommend treatment with corticosteroids, such as prednisone, to reduce swelling behind your eyeballs. In some cases, a surgical procedure may be an option:
- Orbital decompression surgery. In this surgery, your doctor removes the bone between your eye socket and your sinuses — the air spaces next to the eye socket. When the procedure is successful, it improves vision and provides room for your eyes to return to their normal position. But there is a risk of complications, including double vision that persists or appears after surgery.
- Eye muscle surgery. Sometimes scar tissue from Graves' ophthalmopathy can cause one or more eye muscles to be too short. This pulls your eyes out of alignment, leading to double vision. Eye muscle surgery may help correct double vision by cutting the affected muscle from the eyeball and reattaching it farther back. The goal is to achieve single vision when you read and look straight ahead. In some cases, you may need more than one operation to attain these results.
Lifestyle and home remedies
Once you begin treatment, symptoms of hyperthyroidism should subside and you should start feeling much better. The following suggestions also may help:
Ask your doctor about supplementing your diet. If you've lost a great deal of weight or experienced muscle wasting, you may benefit from adding extra calories and protein to your diet. Your doctor or a dietitian can help you with meal planning. In most cases, you won't need to continue supplementing your diet once your hyperthyroidism is under control.
Treatment for hyperthyroidism can also eventually contribute to excessive weight gain. It is important to learn how to get as much nutrition as possible from your food without eating a lot of extra calories. In addition, eating the correct amount of sodium and calcium are important dietary considerations for people with hyperthyroidism.
- Get enough calcium and vitamin D. Because hyperthyroidism may contribute to thinning bones, it's important to get enough calcium every day to help prevent osteoporosis. The Institute of Medicine recommends 1,000 milligrams (mg) of calcium a day for adults ages 19 to 50 and men ages 51 to 70. That calcium recommendation increases to 1,200 mg a day if you're a woman age 51 or older or a man age 71 or older. The Institute of Medicine also recommends 600 international units (IUs) of vitamin D a day for adults ages 19 to 70 and 800 IUs a day for adults age 71 and older. Talk to your doctor about appropriate dietary guidelines for you.
If you have Graves' ophthalmopathy or dermopathy, the following suggestions may help soothe your eyes or skin:
- Apply cool compresses to your eyes. The extra moisture may provide relief.
- Wear sunglasses. When your eyes protrude, they're more vulnerable to ultraviolet rays and more sensitive to sunlight. Wearing sunglasses helps protect them from both sun and wind.
- Use lubricating eyedrops. Eyedrops may help relieve dryness and scratchiness. Be sure to use eyedrops that don't contain redness removers. Because your eyelids may not cover the entire eye when sleeping, a lubricating gel can be used before bed to prevent the cornea from drying out.
- Elevate the head of your bed. Keeping your head higher than the rest of your body may reduce swelling and may help relieve pressure on your eyes.
- Try over-the-counter creams for swollen skin. Over-the-counter creams containing hydrocortisone (Cortaid, others) may help relieve red, swollen skin on your shins and feet. For help finding these creams, talk to your pharmacist.
Coping and support
If you've been diagnosed with hyperthyroidism, the most important thing is to receive the necessary medical care. After you and your doctor have decided on a course of action, there are some things you can do that will help you cope with the condition and support your body during its healing process.
- Get regular exercise. Exercise in general will help you feel better and improve your muscle tone and cardiovascular system. Weight-bearing exercise is important for people with Graves' disease because it helps maintain bone density. Exercise also can help reduce your appetite and increase your energy level.
- Learn relaxation techniques. Many relaxation techniques can help you maintain a positive outlook, especially when coping with illness. It is well-documented that in Graves' disease stress is a risk factor, so learning to relax and achieve balance in your life can help maintain physical and mental well-being.
Preparing for your appointment
You're likely to start by seeing your family doctor or a general practitioner. However, in some cases, you may be referred immediately to a doctor who specializes in the body's hormone-secreting glands (endocrinologist). If you have eye involvement, you may also be referred to an eye doctor (ophthalmologist).
It's good to prepare for your appointment. Here's some information to help you get ready for your appointment, and to know what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements you're taking.
- Take a family member or friend along, if possible. Someone who accompanies you may remember information you missed or forgot.
- Write down questions to ask your doctor.
Preparing a list of questions will help you make the most of your time with your doctor. For hyperthyroidism, some basic questions to ask your doctor include:
- What is likely causing my symptoms or condition?
- Are there other possible causes for my symptoms or condition?
- What tests do I need?
- Is my condition likely temporary or chronic?
- What is the best course of action?
- What are the alternatives to the primary approach you're suggesting?
- I have these other health conditions. How can I manage them together?
- Are there any restrictions that I need to follow?
- Should I see a specialist?
- Is there a generic alternative to the medicine you're prescribing?
- Do you have brochures or other printed material I can take? What websites do you recommend?
Don't hesitate to ask any other relevant questions you have.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, including:
- When did you begin having symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, makes your symptoms worse?
- Do other members of your family have thyroid disease?
- Have you had any recent radiology scans that used intravenous contrast?
Oct. 28, 2015