Hyperthyroidism, also known as overactive thyroid, is a condition in which the thyroid gland produces excess thyroid hormones. This speeds up metabolism and can cause a variety of symptoms. Hyperthyroidism requires treatment, as leaving it untreated can lead to serious complications. But is it an urgent condition that requires immediate treatment?
What is Hyperthyroidism?
The thyroid gland is located in the front of the neck and produces thyroid hormones that regulate metabolism. In hyperthyroidism, the thyroid is overactive and produces too much of the hormones thyroxine (T4) and triiodothyronine (T3).
Some common causes of hyperthyroidism include:
- Graves’ disease – autoimmune disorder that causes the thyroid to produce excess hormones.
- Toxic adenoma – benign tumor of the thyroid that produces hormones.
- Toxic multinodular goiter – enlarged thyroid with multiple nodules that overproduce hormones.
- Thyroiditis – inflammation of the thyroid that causes excess hormone release.
- Overconsumption of thyroid hormone medications.
Signs and Symptoms
Some common signs and symptoms of hyperthyroidism include:
- Unexplained weight loss
- Rapid heartbeat (tachycardia)
- Trembling hands
- Sweating
- Fatigue
- Muscle weakness
- Hair loss
- Irregular menstrual cycles in women
- Anxiety
- Irritability
- Difficulty tolerating heat
- Diarrhea
- Bulging eyes (exophthalmos)
When is it Urgent?
Most cases of hyperthyroidism do not require emergency treatment. However, there are some situations where hyperthyroidism can become life-threatening and require urgent medical care:
- Thyroid storm – Extremely high thyroid hormone levels that result in a fever, rapid pulse, nausea, and even delirium or coma. This requires hospitalization.
- Heart problems – Uncontrolled hyperthyroidism strains the heart and can lead to atrial fibrillation, congestive heart failure, or angina.
- Brittle bones – High thyroid hormone levels raise the risk of osteoporosis and bone fractures.
- Thyroid enlargement – A severely enlarged thyroid, called a goiter, may cause difficulty swallowing and breathing.
Pregnant women with uncontrolled hyperthyroidism also require urgent treatment, as the condition can endanger the health of the mother and baby.
When to Seek Emergency Care
You should seek emergency medical care if you experience:
- Racing, irregular heartbeat
- Shortness of breath
- Dizziness
- Fever over 100.4°F (38°C)
- Vomiting
- Chest pain
- Severe unexplained weakness
- Fainting
These can indicate a thyroid storm or other life-threatening complication that requires prompt treatment.
Diagnosis
If hyperthyroidism is suspected, the doctor will do a physical exam and order lab tests including:
- TSH level – Usually low in hyperthyroidism
- Free T4 and Free T3 – High in hyperthyroidism
- Thyroid antibodies – Present if due to Graves’ disease
Other tests may include a thyroid scan, thyroid ultrasound, or thyroid biopsy.
TSH Reference Range
| Age | Normal TSH Level |
|---|---|
| Newborn to 6 months | 0.7-15.2 uIU/mL |
| 6 months to 2 years | 0.8-8.4 uIU/mL |
| 2-20 years | 0.7-5.7 uIU/mL |
| 20-40 years | 0.4-4.0 uIU/mL |
| 40-60 years | 0.4-5.0 uIU/mL |
| Over 60 years | 0.5-8.9 uIU/mL |
Treatment
Treatment options for hyperthyroidism include:
- Antithyroid medications – Methimazole and propylthiouracil block thyroid hormone production.
- Radioactive iodine – Damages thyroid cells to reduce hormone output.
- Surgery – Removes part or all of the thyroid gland.
- Beta blockers – Control rapid heart rate and reduce symptoms until other treatments take effect.
The choice of treatment depends on the underlying cause, severity of symptoms, and other patient factors.
Antithyroid Medications
Methimazole (Tapazole) and propylthiouracil (PTU) are thionamides that prevent the thyroid from producing excess hormones. They are often used as initial treatment for hyperthyroidism.
- Methimazole is most commonly prescribed in the US.
- PTU is avoided in some cases due to risk of liver toxicity.
- Treatment is usually needed for 12-18 months.
- Side effects include rash, itching, nausea, and joint pain.
Radioactive Iodine
Radioactive iodine treatment involves taking a oral dose of I-131, which is absorbed by the thyroid gland. This damages thyroid cells and prevents excess hormone production. It is a common definitive treatment for hyperthyroidism.
- Takes effect in 6-12 weeks.
- Causes permanent hypothyroidism in most patients, requiring lifelong thyroid hormone replacement.
- Not used in pregnant or breastfeeding women.
- Patients are radioactive for a short time after treatment.
Surgery
Thyroidectomy involves surgical removal of part or all of the thyroid gland. This is an option if medications or radioactive iodine are not appropriate or fail to control hyperthyroidism.
- Often cures hyperthyroidism.
- Carries risks including damage to vocal cords and parathyroid glands.
- Requires lifelong thyroid hormone replacement.
Follow Up Care
After starting treatment for hyperthyroidism, follow up care is needed to:
- Monitor thyroid hormone levels.
- Adjust medication dosages as needed.
- Check for treatment side effects.
- Evaluate the heart for signs of damage from hyperthyroidism.
- Screen for bone loss in those at high risk.
Lifelong monitoring is required for patients who had radioactive iodine treatment or surgery.
Complications
Potential complications of uncontrolled hyperthyroidism include:
- Irregular heartbeat (atrial fibrillation)
- Heart failure
- Brittle bones (osteoporosis)
- Thyroid storm
- Congestive heart failure
- Pregnancy complications including preeclampsia, low birth weight, miscarriage
Prompt treatment can prevent severe complications and avoid long-term consequences of hyperthyroidism.
Conclusion
While hyperthyroidism itself is rarely an immediate emergency, some of its complications can be life-threatening. Seek urgent medical care for signs of thyroid storm, heart problems, or difficulty breathing or swallowing. Schedule prompt medical evaluation for significant unexplained weight loss, palpitations, or heat intolerance.
With early diagnosis and treatment, most cases of hyperthyroidism can be well managed. Work closely with your doctor to find the right treatment plan for you and follow their advice for ongoing monitoring and care.