Hyperthyroidism

If the cause of hyperthyroidism is Graves disease, eye symptoms (sometimes called thyroid eye disease) include puffiness around the eyes, increased tear formation, irritation, and unusual sensitivity to light. Two distinctive additional symptoms may occur:

The eyes bulge outward because of inflammation in the eye sockets (orbits). The muscles that move the eyes become inflamed and unable to function properly, making it difficult or impossible to move the eyes normally or to coordinate eye movements, resulting in double vision. The eyelids may not close completely (called eyelid lag), exposing the eyes to injury from foreign particles and dryness. These eye changes may begin before any other symptoms of hyperthyroidism, providing an early clue to Graves disease, but most often eye changes occur when other symptoms of hyperthyroidism are noticed. Eye symptoms may even appear or worsen after the excessive thyroid hormone secretion has been treated and controlled.

When Graves disease affects the eyes, there may also be thickening of the skin, usually over the shins, which has the texture of an orange-peel. The thickened area may be itchy and red and feels hard when pressed with a finger. As with deposits behind the eyes, this problem may begin before or after other symptoms of hyperthyroidism are noticed.

Thyroid storm, which is sudden extreme overactivity of the thyroid gland, is a life-threatening emergency. All body functions are accelerated to dangerously high levels. Severe strain on the heart can lead to a life-threatening irregular heartbeat (arrhythmia), extremely fast pulse, and shock. Thyroid storm may also cause fever, extreme weakness, restlessness, mood swings, confusion, altered consciousness (even coma), and an enlarged liver with mild jaundice (a yellowish discoloration of the skin and the whites of the eyes).

Thyroid storm is generally caused by untreated or inadequately treated hyperthyroidism and can be triggered by infection, injury, surgery, poorly controlled diabetes, pregnancy or labor, or other stresses. Also, thyroid storm can occur when medications being used to treat thyroid problems are stopped. It is rare in children.

Thyroid storm is diagnosed by a person's symptoms and examination findings. People are treated with medications used to treat hyperthyroidism and with measures to treat complications (such as fever or altered consciousness), typically in an intensive care unit.

Radioactive iodine may be given by mouth to destroy part of the thyroid gland. This is the most common treatment for hyperthyroidism. The radioactivity is mainly delivered to the thyroid gland because the thyroid gland takes up the iodine and concentrates it. Hospitalization is rarely necessary. After treatment, the person should probably not be near infants and young children for 2 to 4 days and should sleep in a separate bed separated at least 6 feet (about 2 meters) from the partner. Pregnancy should be avoided for about 6 to 12 months. People who have had radioactive iodine treatment should stay at least 6 feet away from pregnant women, infants, or small children for 6 to 23 days; the amount of time depends on the dose received. People who have had radioactive iodine treatment may set off radiation alarms at airports and sometimes other places for several weeks after treatment and, therefore, should carry a doctor’s note describing their treatment if they travel on public transportation.

Some doctors try to adjust the dose of radioactive iodine to destroy only enough of the thyroid gland to bring its hormone production back to normal, without reducing thyroid function too much. Other doctors use a larger dose to completely destroy the thyroid. Most of the time, people who undergo this treatment must take thyroid hormone replacement therapy Treatment Hypothyroidism is underactivity of the thyroid gland that leads to inadequate production of thyroid hormones and a slowing of vital body functions. Facial expressions become dull, the voice... read more for the rest of their life. Although concerns have been raised that radioactive iodine may cause cancer, an increased risk of cancer in people who have had radioactive iodine treatment has never been confirmed. Radioactive iodine is not given to pregnant or nursing women because it crosses the placenta and enters the milk and may destroy the fetus’s or breastfed infant’s thyroid gland.

Methimazole and propylthiouracil are the medications most commonly used to treat hyperthyroidism. They work by decreasing the gland’s production of thyroid hormones. Carbimazole, a medication that is widely used in Europe, is converted into methimazole in the body. Methimazole is usually preferred because propylthiouracil may damage the liver in young people. Pregnant women who take propylthiouracil or methimazole are closely monitored because these medications cross the placenta and can cause goiter or hypothyroidism in the fetus Hypothyroidism in the Newborn Hypothyroidism is decreased production of thyroid hormone. Hypothyroidism in the newborn may occur if there is a structural problem with the thyroid gland. Symptoms may include delayed growth... read more .

Each medication is taken by mouth, beginning with high doses that are later adjusted according to blood test results. These medications can usually control thyroid function within 2 to 3 months. Larger doses of these medications may work more quickly but increase the risk of side effects.

Beta-blockers such as propranolol or metoprolol help control many of the symptoms of hyperthyroidism. These medications can slow a fast heart rate, reduce tremors, and control anxiety. Doctors therefore find beta-blockers particularly useful to control symptoms of hyperthyroidism until the person responds to other treatments. However, beta-blockers do not reduce excess thyroid hormone production. Therefore, other treatments are added to bring hormone production to normal levels.

Iodine, given by mouth, is sometimes used to treat hyperthyroidism. It is reserved for people in whom rapid treatment is needed, such as those with thyroid storm. It may also be used to control hyperthyroidism until the person can have surgery to remove the thyroid. It is not used long-term.

Surgery to remove part or all of the thyroid gland, called thyroidectomy, is a treatment option for people with hyperthyroidism, especially for children and adolescents with Graves disease. Surgery is also an option for people who have a very large goiter as well as for those who are allergic to or who develop severe side effects from the medications used to treat hyperthyroidism or those who do not want radiation exposure. Hyperthyroidism is permanently controlled in more than 90% of people who choose this option. Hypothyroidism often occurs after surgery, and people then have to take replacement thyroid hormone for the rest of their life. Rare complications of surgery include paralysis of the vocal cords and damage to the parathyroid glands (the tiny glands behind the thyroid gland that control calcium levels in the blood).

In Graves disease, additional treatment may be needed for the eye and skin symptoms. Eye symptoms may be helped by elevating the head of the bed, by applying eye drops, by sleeping with the eyelids taped shut, and, occasionally, by taking selenium, teprotumumab, or diuretics (medications that hasten fluid excretion). Double vision may be helped by using eyeglass prisms. Finally, corticosteroids taken by mouth, x-ray treatment to the orbits, or eye surgery may be needed if the eyes are severely affected. Corticosteroid creams or ointments can help relieve the itching and hardness of the abnormal skin. Often the problem disappears without treatment months or years later.