Overactive thyroid

Introduction

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The thyroid gland is a part of the body’s endocrine (hormone) system – which is made up of the glands that help regulate many of the body’s different functions. If the thyroid gland is overactive, it produces too much of the thyroid hormone thyroxine. An overactive thyroid (medical term: hyperthyroidism) can be caused by various things. The most common cause is a condition known as Graves’ disease.

The higher levels of thyroid unnecessarily speed up a lot of functions in the body. This can lead to noticeable symptoms such as weight loss, sweating, nervousness or a rapid heartbeat. An overactive thyroid increases the risk of cardiovascular disease (problems affecting the heart and/or blood vessels).

If the thyroid gland doesn’t produce enough , the body’s functions slow down. This problem is known as an underactive thyroid or hypothyroidism.

Symptoms

Hyperthyroidism often causes the thyroid gland, which is located at the front of the neck, to become noticeably larger. A swollen thyroid is called a goiter. The whole gland isn’t always swollen. A lump (nodule) may be felt or seen instead. But some people have an overactive thyroid without a goiter or thyroid nodule – and those who have a goiter or nodules don’t always have an overactive thyroid.

If there are too many thyroid in your blood, various metabolic and body functions get out of balance. This can cause symptoms such as:

  • a pounding heart (palpitations) and rapid heartbeat, and sometimes an irregular heartbeat too
  • high blood pressure
  • weight loss despite an increased appetite
  • diarrhea
  • trembling, nervous restlessness, irritability, sleep problems
  • weakness, tiredness

People who have an overactive thyroid often sweat a lot and feel uncomfortable when they are warm. Their skin is often warm and moist to the touch, and they may have thinning hair.

The most noticeable symptom of Graves’ disease affects the eyes: they bulge out visibly, and people may have vision problems (double vision). In rare cases, Graves’ disease also leads to swelling in the lower legs, or in the tips of the fingers or toes.

Causes

The most common cause of an overactive thyroid gland is Graves’ disease. This condition arises from a disorder of the body's immune system. The then produces antibodies that make the thyroid gland grow and release too many .

Hyperthyroidism may also arise if thyroid gland cells start producing “autonomously” – in other words, without being "told" to. The activity of the thyroid gland is usually regulated by the pituitary gland. Sometimes, though, the thyroid gland cells no longer react to signals from the pituitary gland. As a result, the thyroid gland may produce far more than are actually needed. These autonomous cells are sometimes found in the whole thyroid gland, and sometimes they are only found in one or several benign (non-cancerous) growths called nodules. The medical term for nodules like this is thyroid adenomas. High thyroid hormone levels are only very rarely caused by malignant (cancerous) thyroid tumors.

Sometimes there are too many thyroid in the blood even though the thyroid gland isn’t overactive – for instance, if the thyroid gland is inflamed (thyroiditis). The can destroy thyroid tissue. As a result, thyroid that are stored in the tissue are suddenly released, temporarily leading to symptoms similar to those caused by an overactive thyroid.

Prevalence

About 1 out of 100 people have an overactive thyroid, making it quite a common condition. Graves’ disease is the main cause, affecting about 2 out of 1,000 men and 20 out of 1,000 women. It typically starts between the ages of 20 and 50.

Effects

If people who have an overactive thyroid don’t get proper treatment, they may develop cardiovascular diseases such as atrial fibrillation (an irregular heartbeat). Because their old bone tissue is broken down and new bone tissue is formed at a faster rate, osteoporosis may develop over the long term too.

In rare cases, an overactive thyroid can lead to a potentially life-threatening situation known as a thyrotoxic crisis or a “thyroid storm.” This can be triggered by iodine-containing medication or x-ray contrast agents, for example. It causes the typical symptoms of an overactive thyroid, as well as symptoms such as a high fever, vomiting, restlessness and anxiety, an irregular heartbeat, confusion and drowsiness, and sometimes even loss of consciousness or cardiovascular collapse (where not enough blood flows around the body). A thyroid storm is a medical emergency, requiring immediate hospital treatment in an intensive care unit.

Diagnosis

If it is thought that someone may have an overactive thyroid, the first diagnostic step is usually an in-depth talk with their doctor. The talk is typically followed by a physical examination to palpate (feel) the thyroid gland. This allows the doctor to feel whether the gland is bigger than usual or has any nodules in it. A thorough examination of the rest of the body can detect signs of certain causes. For instance, people with Graves' disease sometimes have bulging, swollen eyes.

Blood tests can provide other important information, including whether the thyroid gland is making too many and whether the production of these is being properly regulated by the pituitary gland. Graves’ disease also causes certain antibodies to be produced, and these can be detected in blood tests.

Ultrasound examinations allow doctors to take a closer look at the thyroid gland tissue and any nodules in the gland. An examination known as a thyroid scan (or thyroid scintigraphy) can be done to see whether the thyroid cells in the nodule are producing more than other thyroid cells. If they are, they are considered to be “hot” nodules.

Treatment

Mild hyperthyroidism sometimes gets better on its own, without treatment. But the overproduction of thyroid is usually first stopped using tablets called anti-thyroid drugs. In Graves’ disease, long-term treatment with this medication can make the thyroid function return to normal. If that doesn’t happen, the thyroid gland is surgically removed or treated with radioactive iodine. Known as radioiodine therapy, this involves swallowing radioactive iodine which is then absorbed by your thyroid gland, where it destroys overactive cells.

If the overactive thyroid is caused by an enlarged thyroid gland with “autonomous” cells, the thyroid gland that has been “slowed down” with anti-thyroid drugs is usually surgically removed. If surgery isn’t possible or the thyroid gland isn’t greatly enlarged, radioiodine therapy tends to be more suitable.

Further Information

When people are ill or need medical advice, they usually go to see their family doctor first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.

De Leo S, Lee SY, Braverman LE. Hyperthyroidism. Lancet 2016; 388(10047): 906-918.

Jameson JL, Mandel SJ, Weetmann AP. Disorders of the Thyreoid Gland. In: D. L. Kaspers, S. L. Hauser, J. L. Jameson, Fauci AS, D. L. Longo, J. Loscalzo (Ed). Harrison's Principles of Internal Medicine. McGraw-Hill Education; 2015.

Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid 2016; 26(10): 1343-1421.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on April 19, 2018
Next planned update: 2021

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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