Hyperthyroidism

Overactive thyroid
Last reviewed: April 19, 2010.

Hyperthyroidism is a condition in which the thyroid gland makes too much thyroid hormone. The condition is often referred to as an "overactive thyroid."

Causes, incidence, and risk factors

The thyroid gland is an important organ of the endocrine system. It is located in the front of the neck just below the voice box. The gland produces the hormones thyroxine (T4) and triiodothyronine (T3), which control the way every cell in the body uses energy. This process is called your metabolism. Hyperthyroidism occurs when the thyroid releases too much of its hormones over a short (acute) or long (chronic) period of time. Many diseases and conditions can cause this problem, including: Getting too much iodine Graves disease (accounts for most cases of hyperthyroidism) Inflammation (thyroiditis) of the thyroid due to viral infections or other causes Noncancerous growths of the thyroid gland or pituitary gland Taking large amounts of thyroid hormone Tumors of the testes or ovaries

Related topics: Factitious hyperthyroidism Hypothyroidism Painless (silent) thyroiditis

Symptoms
Difficulty concentrating Fatigue Frequent bowel movements Goiter (visibly enlarged thyroid gland) or thyroid nodules Heat intolerance Increased appetite Increased sweating Irregular menstrual periods in women Nervousness Restlessness Weight loss (rarely, weight gain)

Other symptoms that can occur with this disease: Breast development in men Clammy skin Diarrhea Hair loss

Hand tremor Weakness High blood pressure Itching - overall Lack of menstrual periods in women Nausea and vomiting Pounding, rapid, or irregular pulse Protruding eyes (exophthalmos) Rapid, forceful, or irregular heartbeat (palpitations) Skin blushing or flushing Sleeping difficulty

Signs and tests

Physical examination may reveal thyroid enlargement, tremor, hyperactive reflexes, or an increased heart rate. Systolic blood pressure (the first number in a blood pressure reading) may be high. Subclinical hyperthyroidism is a mild form of hyperthyroidism that is diagnosed by abnormal blood levels of thyroid hormones, often in the absence of any symptoms. Blood tests are also done to measure levels of thyroid hormones. TSH (thyroid stimulating hormone) level is usually low T3 and free T4 levels are usually high

This disease may also affect the results of the following tests: Cholesterol test Glucose test Radioactive iodine uptake T3RU Triglycerides Vitamin B12 (in rare cases)

Treatment
How the condition is treated depends on the cause and the severity of symptoms. Hyperthyroidism is usually treated with one or more of the following: Antithyroid medications

Radioactive iodine (which destroys the thyroid and stops the excess production of hormones) Surgery to remove the thyroid If the thyroid must be removed with surgery or destroyed with radiation, you must take thyroid hormone replacement pills for the rest of your life. Beta-blockers such as propranolol are used to treat some of the symptoms, including rapid heart rate, sweating, and anxiety until the hyperthyroidism can be controlled.

Expectations (prognosis)
Hyperthyroidism is generally treatable and only rarely is life threatening. Some of its 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.

Complications
Thyroid crisis (storm), also called thyrotoxicosis, is a sudden worsening of hyperthyroidism symptoms that may occur with infection or stress. Fever, decreased mental alertness, and abdominal pain may occur. Immediate hospitalization is needed. Other complications related to hyperthyroidism include: Heart-related complications including: Rapid heart rate Congestive heart failure Atrial fibrillation Increased risk for osteoporosis, if hyperthyroidism is present for a long time 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) Treatments for hypothyroidism, such as radioactive iodine, surgery, and medications to replace thyroid hormones can have complications.

Calling your health care provider

Call your health care provider if you have symptoms that could be caused by too much thyroid hormone production. Go to an emergency room or call the local emergency number (such as 911), if you have: Change in consciousness Dizziness Rapid, irregular heartbeat

Call your health care provider if you are being treated for hyperthyroidism and you develop symptoms of underactive thyroid, including: Depression Mental and physical sluggishness Weight gain

Prevention
There are no known ways to prevent hyperthyroidism.

Hyperthyroidism
What is hyperthyroidism?
Hyperthyroidism means overactivity of the thyroid gland, resulting in too much thyroid hormone in the bloodstream. The oversecretion of thyroid hormones leads to overactivity of the body's metabolism.

Thyroid Gland - Click to Enlarge

What are the symptoms of hyperthyroidism?

The following are the most common symptoms of hyperthyroidism. However, each individual may experience symptoms differently. Symptoms may include:

Nervousness Irritability Increased perspiration Thinning of the skin Fine, brittle hair Weak muscles, especially in the upper arms and thighs Shaky hands Fast heartbeat High blood pressure Increased bowel movements Weight loss Sleeping difficulty Prominent eyes Sensitivity to bright light Confusion Irregular menstrual cycle

The symptoms of hyperthyroidism may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.

Types of hyperthyroidism
There are several forms of hyperthyroidism, including:

Graves' disease (diffuse toxic goiter). Graves' disease is most often associated with hyperthyroidism. Researchers believe Graves' disease is caused by an antibody which stimulates the thyroid too much. This overstimulation causes the excess production of thyroid hormone. Graves' disease is categorized as an autoimmune disorder (a dysfunction of the body's immune system). The disease is most common in young to middle-aged women and tends to run in families.

Symptoms of Graves' disease are identical to hyperthyroidism, with the addition of three other symptoms. However, each individual may experience symptoms differently. The three additional symptoms include:

Goiter (enlarged thyroid which may cause a bulge in the neck) Bulging eyes (exophthalmos) Thickened skin over the shin area

Toxic nodular goiter (also called multinodular goiter). Hyperthyroidism caused by toxic nodular goiter is a condition in which one or more nodules of the thyroid becomes overactive. The overactive nodules actually act as benign thyroid tumors. Symptoms of toxic nodular goiter do not include bulging eyes or skin problems, as in Graves' disease. The cause of toxic nodular goiter is not known.

Thyroiditis. Thyroiditis causes temporary hyperthyroidism, usually followed with hypothyroidism (an underactive thyroid). Thyroiditis is an inflammation of the thyroid gland. There are three types of thyroiditis:

Hashimoto's thyroiditis Subacute granulomatous thyroiditis Silent lymphocytic thyroiditis

In addition, if a person takes too many thyroid hormone tablets, hyperthyroidism may occur.

How is hyperthyroidism diagnosed?

In addition to a complete medical history and medical examination, diagnostic procedures for hyperthyroidism may include:

Measurement of thyroid hormone in the bloodstream Thyroid ultrasound. A test to evaluate the thyroid gland for evidence of any nodules. Thyroid scan. A test that uses a radioactive substance to create an image of the thyroid.

Treatment for hyperthyroidism

Treatment for hyperthyroidism is very specific for each patient. The goal of treatment is to restore the thyroid gland to normal function, producing normal levels of thyroid hormone. Specific treatment for hyperthyroidism will be determined by your doctor based on:

Your age, overall health, and medical history Type of hyperthyroidism Extent of the disease Your tolerance for specific medications, procedures, or therapies Expectations for the course of the disease Your opinion or preference

Treatment may include:

Use of antithyroid drugs that help lower the level of thyroid hormones in the blood. Use of radioactive iodine, in the form of a pill or liquid, which damages thyroid cells so that production of thyroid hormones is slowed down.

Surgery to remove part of the thyroid (the overactive nodule). Use of beta-blocking agents, which block the action of thyroid hormone on the body; (These drugs do not change the levels of thyroid hormone in the blood, but may make the patient feel better.)

-Facts about hyperthyroidism: Less than 1 percent of people in the US have hyperthyroidism. Hyperthyroidism usually occurs between the ages of 30 and 50. Hyperthyroidism is more common in women than in men.

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Incidence (annual) of Congenital hypothyroidism:

about 1 in 4000 babies

Incidence Rate for Congenital hypothyroidism: approx 1 in 272,000 or 0.00% or 1,000 people in USA [about data]Extrapolation of Incidence Rate for Congenital hypothyroidism to Countries and Regions: WARNING! EXTRAPOLATION ONLY. NOT BASED ON COUNTRY-SPECIFIC DATA SOURCES. The following table attempts to extrapolate the above incidence rate for Congenital hypothyroidism to the populations of various countries and regions. As discussed above, these incidence extrapolations for Congenital hypothyroidism are only estimates and may have very limited relevance to the actual incidence of Congenital hypothyroidism in any region:

Country/Region USA Canada Mexico Belize Guatemala Nicaragua Puerto Rico Brazil Chile Colombia Paraguay Peru Venezuela Denmark Finland Iceland Sweden

Extrapolated Incidence 1,079 119 WARNING! (Details) 385 WARNING! (Details) 1 WARNING! (Details) 52 WARNING! (Details) 19 WARNING! (Details) 14 WARNING! (Details) 676 WARNING! (Details) 58 WARNING! (Details) 155 WARNING! (Details) 22 WARNING! (Details) 101 WARNING! (Details) 91 WARNING! (Details) 19 WARNING! (Details) 19 WARNING! (Details) 1 WARNING! (Details) 33 WARNING! (Details)

Population Estimated Used 293,655,405 32,507,874

2 2 1

Congenital hypothyroidism in North America (Extrapolated Statistics)

104,959,594 272,945
2 2

Congenital hypothyroidism in Central America (Extrapolated Statistics) 14,280,596 5,359,759 3,897,960

2

Congenital hypothyroidism in Caribbean (Extrapolated Statistics)

2

Congenital hypothyroidism in South America (Extrapolated Statistics) 184,101,109 15,823,957 42,310,775 6,191,368
2 2 2 2 2 2

27,544,305 25,017,387 5,413,392 5,214,512 293,966

2 2 2 2

Congenital hypothyroidism in Northern Europe (Extrapolated Statistics)

8,986,400

Congenital hypothyroidism in Western Europe (Extrapolated Statistics) Britain (United Kingdom) 221 WARNING! (Details) 60,270,708 for UK
2

Belgium France Ireland Luxembourg Monaco Netherlands (Holland) United Kingdom Wales Austria Czech Republic Germany Hungary Liechtenstein Poland Slovakia Slovenia Switzerland Belarus Estonia Latvia Lithuania Russia Ukraine Azerbaijan Portugal Spain Georgia Italy Greece Albania Bulgaria Croatia Macedonia

38 WARNING! (Details) 222 WARNING! (Details) 14 WARNING! (Details) 1 WARNING! (Details) 0 WARNING! (Details) 59 WARNING! (Details) 221 WARNING! (Details) 10 WARNING! (Details) 30 WARNING! (Details) 4 WARNING! (Details) 303 WARNING! (Details) 36 WARNING! (Details) 0 WARNING! (Details) 142 WARNING! (Details) 19 WARNING! (Details) 7 WARNING! (Details) 27 WARNING! (Details) 37 WARNING! (Details) 4 WARNING! (Details) 8 WARNING! (Details) 13 WARNING! (Details) 529 WARNING! (Details) 175 WARNING! (Details) 28 WARNING! (Details) 38 WARNING! (Details) 148 WARNING! (Details) 17 WARNING! (Details) 213 WARNING! (Details) 39 WARNING! (Details) 13 WARNING! (Details) 27 WARNING! (Details) 16 WARNING! (Details) 7 WARNING! (Details)

10,348,276 60,424,213 3,969,558 462,690 32,270

2 2 2

2 2

16,318,199 60,270,708 2,918,000 8,174,762

2

2 2

Congenital hypothyroidism in Central Europe (Extrapolated Statistics)

2 2 2 2

1,0246,178 82,424,609 10,032,375 33,436

2

38,626,349 5,423,567 2,011,473 7,450,867

2

2 2

Congenital hypothyroidism in Eastern Europe (Extrapolated Statistics) 10,310,520 1,341,664 2,306,306 3,607,899
2 2 2 2 2

143,974,059 47,732,079 7,868,385

2 2 2 2

Congenital hypothyroidism in the Southwestern Europe (Extrapolated Statistics) 10,524,145 40,280,780 4,693,892
2

Congenital hypothyroidism in the Southern Europe (Extrapolated Statistics) 58,057,477 10,647,529 3,544,808 407,608
2 2 2 2 2 2 2

Congenital hypothyroidism in the Southeastern Europe (Extrapolated Statistics) Bosnia and Herzegovina 1 WARNING! (Details)

7,517,973 4,496,869 2,040,085

Romania Serbia and Montenegro Mongolia Kazakhstan Tajikistan Uzbekistan China Hong Kong s.a.r. Japan Macau s.a.r. North Korea South Korea Taiwan Turkey Afghanistan Bangladesh Bhutan India Pakistan Sri Lanka East Timor Indonesia Laos Malaysia Philippines Singapore Thailand Vietnam Gaza strip Iran Iraq Israel

82 WARNING! (Details) 39 WARNING! (Details) 10 WARNING! (Details) 55 WARNING! (Details) 25 WARNING! (Details) 97 WARNING! (Details)

22,355,551 10,825,900 2,751,314

2

2 2

Congenital hypothyroidism in Northern Asia (Extrapolated Statistics) Congenital hypothyroidism in Central Asia (Extrapolated Statistics) 15,143,704 7,011,556 26,410,416
2 2 2

Congenital hypothyroidism in Eastern Asia (Extrapolated Statistics) 4,775 WARNING! (Details) 1,298,847,624 25 WARNING! (Details) 468 WARNING! (Details) 1 WARNING! (Details) 83 WARNING! (Details) 177 WARNING! (Details) 83 WARNING! (Details) 253 WARNING! (Details) 104 WARNING! (Details) 519 WARNING! (Details) 8 WARNING! (Details) 585 WARNING! (Details) 73 WARNING! (Details) 3 WARNING! (Details) 876 WARNING! (Details) 22 WARNING! (Details) 86 WARNING! (Details) 317 WARNING! (Details) 16 WARNING! (Details) 238 WARNING! (Details) 303 WARNING! (Details) 4 WARNING! (Details) 248 WARNING! (Details) 93 WARNING! (Details) 22 WARNING! (Details) 6,855,125 445,286
2 2 2 2 2 2 2

127,333,002 22,697,553 48,233,760 22,749,838 68,893,918 28,513,677 2,185,569

2

Congenital hypothyroidism in Southwestern Asia (Extrapolated Statistics)

2

Congenital hypothyroidism in Southern Asia (Extrapolated Statistics)

2 2

141,340,476

3,915 WARNING! (Details) 1,065,070,607 159,196,336 19,905,165 1,019,252 6,068,117

2 2 2 2

Congenital hypothyroidism in Southeastern Asia (Extrapolated Statistics) 238,452,952

2 2 2

23,522,482 86,241,697 4,353,893

2

64,865,523 82,662,800 1,324,991

2

2 2

Congenital hypothyroidism in the Middle East (Extrapolated Statistics) 67,503,205 25,374,691 6,199,008
2 2 2

Jordan Kuwait Lebanon Saudi Arabia Syria United Arab Emirates West Bank Yemen Egypt Libya Sudan Congo Brazzaville Ghana Liberia Niger Nigeria Senegal Sierra leone

20 WARNING! (Details) 8 WARNING! (Details) 13 WARNING! (Details) 94 WARNING! (Details) 66 WARNING! (Details) 9 WARNING! (Details) 8 WARNING! (Details) 73 WARNING! (Details) 279 WARNING! (Details) 20 WARNING! (Details) 143 WARNING! (Details) 11 WARNING! (Details) 76 WARNING! (Details) 12 WARNING! (Details) 41 WARNING! (Details) 65 WARNING! (Details) 39 WARNING! (Details) 21 WARNING! (Details)

5,611,202 2,257,549 3,777,218

2 2 2 2 2

25,795,938 18,016,874 2,523,915 2,311,204

2 2

20,024,867 76,117,421 5,631,585

2

Congenital hypothyroidism in Northern Africa (Extrapolated Statistics)

2

39,148,162 2,998,040 3,390,635

2

Congenital hypothyroidism in Western Africa (Extrapolated Statistics) 20,757,032

2 2 2 2

11,360,538 10,852,147 5,883,889 3,742,482 9,538,544 8,238,673

2

12,5750,356
2

Congenital hypothyroidism in Central Africa (Extrapolated Statistics) Central African Republic 13 WARNING! (Details) Chad Congo kinshasa Rwanda Ethiopia Kenya Somalia Tanzania Uganda Angola Botswana South Africa Swaziland Zambia Zimbabwe 35 WARNING! (Details) 214 WARNING! (Details) 30 WARNING! (Details) 262 WARNING! (Details) 121 WARNING! (Details) 30 WARNING! (Details) 132 WARNING! (Details) 97 WARNING! (Details) 40 WARNING! (Details) 6 WARNING! (Details) 163 WARNING! (Details) 4 WARNING! (Details) 40 WARNING! (Details) 13 WARNING! (Details)
2 2 2

58,317,030
2

Congenital hypothyroidism in Eastern Africa (Extrapolated Statistics) 71,336,571 32,982,109 8,304,601

2 2 2 2 2

36,070,799 26,390,258 10,978,552 1,639,231 1,169,241

2

Congenital hypothyroidism in Southern Africa (Extrapolated Statistics)

2

44,448,470
2

11,025,690 1,2671,860

2 2

Congenital hypothyroidism in Oceania (Extrapolated Statistics)

Australia New Zealand Papua New Guinea

73 WARNING! (Details) 14 WARNING! (Details) 19 WARNING! (Details)

19,913,144 3,993,817 5,420,280

2 2

About extrapolations of prevalence and incidence statistics for Congenital hypothyroidism:

WARNING! EXTRAPOLATED STATISTICS ONLY! Not based on data sources from individual countries. These statistics are calculated extrapolations of various prevalence or incidence rates against the populations of a particular country or region. The statistics used for prevalence/incidence of Congenital hypothyroidism are typically based on US, UK, Canadian or Australian prevalence or incidence statistics, which are then extrapolated using only the population of the other country. This extrapolation calculation is automated and does not take into account any genetic, cultural, environmental, social, racial or other differences across the various countries and regions for which the extrapolated Congenital hypothyroidism statistics below refer to. The extrapolation does not use data sources or statistics about any country other than its population. As such, these extrapolations may be highly inaccurate (especially for developing or third-world countries) and only give a general indication (or even a meaningless indication) as to the actual prevalence or incidence of Congenital hypothyroidism in that region. These statistics are presented only in the hope that they may be interesting to some people.

About prevalence and incidence statistics in general for Congenital hypothyroidism:

The word 'prevalence' of Congenital hypothyroidism usually means the estimated population of people who are managing Congenital hypothyroidism at any given time (i.e. people with Congenital hypothyroidism). The term 'incidence' of Congenital hypothyroidism means the annual diagnosis rate, or the number of new cases of Congenital hypothyroidism diagnosed each year (i.e. getting Congenital hypothyroidism). Hence, these two statistics types can differ: a short disease like flucan have high annual incidence but low prevalence, but a life-long disease like diabetes has a low annual incidence but hANATOMY

AND PHYSIOLOGY OF THE THYROID GLAND

A normal adult thyroid gland usually weighs 10 to 20 g. It receives its nourishment from bilateral superior and inferior thyroid arteries and a small artery called thyroid ima. The thyroid gland secretes two thyroid hormones (THs). Thyroxine (T 4) represents 90% of thyroid hormone production, whereas triiodothyronine (T 3) comprises 10%. Peripheral tissues convert T 4 to T3 and most T3 is derived from T4. TH secretion is regulated by the hypothalamus-pituitary-thyroid axis through the actions of thyroid-releasing hormone (TRH) and thyroid-stimulating hormone (TSH).

Thyroid hormones are transported in serum bound to carrier proteins and only 0.03% to 0.04% of T 4 and 0.3% to 0.4% of T3 exist as a free hormone. Thyroid-binding globulin (TBG) is the main carrier, accounting for 75% of bound T4 and all bound T3. Thyroxine-binding prealbumin (TBPA) accounts for 15% of T4binding, and albumin

-igh prevalence. For more information see about prevalence and incidence statistics.