YOU and Your Doctor Are Your Medical Team – June 2024

This topic is an overview of thyroid disease. This month will be part #1 and address Hyperthyroidism, and next month, part #2 will be about Hypothyroidism. The thyroid is a small gland, shaped like a “butterfly” located in the front of the neck, circling the windpipe/(trachea). Your thyroid makes hormones that help control many vital functions of your body, especially controlling your metabolism. Metabolism is the process where the food you eat is transformed into energy. This energy is used throughout your entire body to keep many of your body’s systems working correctly. When your thyroid doesn’t work properly, it can impact your entire body.

When your thyroid hormone levels are too high or too low, your body can’t work right, which can affect your energy level, mood, and weight. If your body makes too much thyroid hormone, you can develop a condition called hyperthyroidism. If your body makes too little thyroid hormone, it’s called hypothyroidism. Both conditions are serious with potentially harsh heath consequences if not identified and managed.

Hyperthyroidism can be caused by a number of things: (a) a toxic nodule; (b) multiple toxic nodules (goiter) usually occurs after age 50 and you may have had it for any years before the thyroid starts to produce excess amounts of hormones. (c) subacute thyroiditis – a type of hyperthyroidism that can follow a viral infection which causes inflammation of the thyroid gland and usually over time returns to its normal state; (d) excessive iodine ingestion – some food sources with high concentration, i.e., over-the-counter iron supplements, kelp tablets, some expectorants, amiodarone (a medication used to treat certain heart rhythm problems), and x-ray dyes. This condition usually resolves when the supplement is discontinued. (d) over medication of thyroid hormone – people who take too much thyroid hormone replacement can also develop hyperthyroidism. Patients should have their thyroid hormone levels checked at least once a year and should NEVER give themselves “extra” doses unless directed by their physician. (e) changes in thyroid medication should always be guided by thyroid function testing.

Graves’ Disease and hyperthyroidism are not exactly the same. Graves’ disease is an autoimmune condition that can cause hyperthyroidism by attacking/damaging the thyroid, often enlarging the gland. Some people with Graves’ disease often have their eyes and vision affected. People may notice that their eyes become more prominent, the eyelids do not properly close, they have a “gritty” sensation and general irritation of the eyes, increased tear production. The eyeballs may seem to be bulging and may cause painful or double vision. Decreased vision and damage to the cornea can also occur in severe cases. Like other autoimmune diseases, this condition may occur in other family members and is more common in women than men. Studies have shown that in those who have hyperthyroid disease it is caused 60 to 80% of the time by Graves’ Disease – an autoimmune condition.

Some early signs of HYPERthyroidism: Losing weight without trying, fast heartbeat – a condition called tachycardia, irregular heartbeat/arrhythmia, pounding of the heart – heart palpitations, increased hunger, difficulty sleeping, nervousness, anxiety and irritability, mood swings, tremor/trembling/twitching – usually a small trembling in the hands and fingers, sweating, sensitivity to heat, persistent tiredness and weakness, swelling in the neck from an enlarged thyroid gland (goiter), and memory loss or decreased concentration.

If you have diabetes, you’re at a higher risk of developing thyroid disease than people without diabetes. Type 1 diabetes is an autoimmune disorder. If you already have one autoimmune disorder, you are more likely to develop another one. For people with Type 2 diabetes, the risk is lower, but still there. People with Type 2 diabetes are more likely to develop thyroid disease later in life. Regular testing is recommended to check for thyroid issues. Those with Type 1 diabetes may be tested more often – immediately after diagnosis and thereafter at least every year, more so than people with Type 2 diabetes. Your healthcare provider may suggest a schedule for testing over time for your unique medical needs.

You can do a quick and easy self-exam of your thyroid at home. For this self-exam you need a mirror and a glass of water. Self-exam steps: (a) with the mirror pointed toward your neck / throat/thyroid area, (b) take a small sip of water and swallow. (c) repeat this test a few times to get a good look at your thyroid/throat area. If you see any lumps or bumps, make an appointment to be examined by the doctor, who may also order blood tests.

The main treatments of an overactive thyroid: (a) medicine that stops your thyroid producing too much of the thyroid hormone; (b) radioactive iodine treatment – where a type of radiotherapy is used to destroy cells in the thyroid, reducing its ability to produce thyroid hormones; (c) surgery to remove some or all of the thyroid, so that it no longer produces thyroid hormones. This is a topic to be discussed with your physician as to which approach should be taken, as each person is an individual with unique health situations. You’ll may be referred to a specialist in hormonal conditions (endocrinologist) to discuss which treatment is best for you.

Treatment for Graves’ disease is lifelong. People who receive definitive treatment for Graves’ disease (radioactive iodine or thyroidectomy) will eventually develop hypothyroidism (underactive thyroid), which requires lifelong medication. People who take anti-thyroid drugs to treat Graves’ disease usually have to take them throughout their life.

Untreated or poorly managed Graves’ disease increases your risk for these complications: Heart disease – arrhythmia (irregular heartbeat). Arrhythmia increases your risk of stroke, heart failure, and other heart conditions; Osteoporosis – abnormal thinning and weakness of your bones, which can make you susceptible to repeated bone fractures; and “thyroid storm,” also called thyroid crisis and thyrotoxic crisis, when your thyroid gland releases a large amount of thyroid hormone in a short amount of time. It’s a rare complication of hyperthyroidism and Graves’ disease and can happen if you suddenly stop taking your anti-thyroid medication or experience trauma or an infection. Thyroid storm is a medical emergency and is life-threatening. Symptoms include high fever and a rapid heart rate.

A person with hyperthyroidism should avoid eating excessive amounts of iodine-rich foods, such as: iodized salt, tuna, shrimp, other fish and shellfish, seaweed/ kelp, iodine supplements, food products containing red dye, egg yolks, blackstrap molasses, fruits like strawberries, cranberries and pineapple, and beans. Green beans and navy beans are noted for their high iodine content. Caffeine can cause an increase in heart rate, palpitations, and may exacerbate anxiety and insomnia symptoms. When diagnosed with hyperthyroidism, try to avoid coffee, sugar drinks and other caffeinated stimulants. Refrain from or reduce the consumption of chocolate, energy drinks, soda, black tea, and coffee. Gluten can also trigger thyroid inflammatory responses. Dairy products are often high in iodine. Alcohol consumption can be harmful to the thyroid gland by impairing the body’s general capacity to use and absorb thyroid hormone. It is wise to monitor your food choices that are high in iodine as excessive amounts can exacerbate/worsen symptoms. Discuss with your doctor your calcium and vitamin D levels, as hyperthyroidism may impact bone health. Consult your healthcare professional and based on your lab reports a diet can be personalized to your unique requirements.

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Jackie Kellum

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