Hyperthyroidism and toxic goitre: symptoms and treatment

Hyperthyroidism vs thyrotoxicosis – what is the difference?

Thyrotoxicosis means raised levels of thyroid hormones (T3 and T4) in the blood. Hyperthyroidism is the increased activity of the gland that causes this rise. Both are popularly known as “toxic goitre”. Hyperthyroidism occurs in:

• Graves’ disease – the most common cause;
• toxic adenoma and toxic nodular goitre – when a nodule in the gland produces hormones itself;
• subacute thyroiditis.

Which symptoms suggest an overactive thyroid?

Hand tremor is sometimes noticeable only on close inspection: if small pieces of paper are placed on outstretched hands, the trembling becomes much clearer. Not feeling cold even in cold weather and being comfortable in light clothing are also reasons to suspect an overactive thyroid. If you have any of these signs, see an endocrinologist without delay:

• unexplained weight loss despite eating normally or even more;
• a fast heartbeat even at rest, shortness of breath;
• trembling hands, moist, sweaty palms;
• heat intolerance, heavy sweating, not feeling cold even in cold weather;
• irritability, anxiety, sleep problems;
• muscle weakness, fatigue, diarrhoea;
• swelling in the neck, bulging and dry eyes;
• menstrual irregularities, difficulty getting pregnant.

What is Graves’ disease?

Graves’ disease is autoimmune: antibodies produced by the body activate TSH receptors and the gland produces too much hormone. Blood tests show a low TSH with high T3 and T4. It occurs most often between the ages of 20 and 50, especially in women.

One characteristic feature of Graves’ is eye involvement (ophthalmopathy, orbitopathy). The antibodies target the eye muscles and the tissues around the eye, causing inflammation and swelling. Sensitivity to light, watering, burning, swollen eyelids, protruding eyes, redness and pain on eye movement may occur. Treatment decisions depend on how severe the eye involvement is.

How are diagnosis and treatment carried out?

Diagnosis involves a physical examination, TSH, free T4 and free T3 tests and a thyroid ultrasound. On colour Doppler, the gland in Graves’ disease appears as a “thyroid inferno”. Scintigraphy is ordered when needed.

Antibodies against TSH receptors may also be measured in the blood to distinguish Graves’ disease from other causes.

Toxic goitre is treated in three ways: with medication (thyrostatic drugs), with radioactive iodine and with surgery. The method is chosen individually according to the type of disease, accompanying conditions and complications.

In Graves’ disease the first-line treatment is medication, lasting about 18 months. If the disease returns after treatment, the medication does not help or serious side effects develop, radioactive iodine or surgery is considered.

To ease palpitations and tremor, the doctor may additionally prescribe medicines that slow the heart rate.

Surgery may be considered in the following cases:

• a large diffuse toxic goitre;
• toxic nodular goitre;
• goitre that does not respond to medication;
• toxic goitre in a woman planning pregnancy;
• the patient declining long-term medical treatment.

What if it is left untreated, and what to avoid?

A persistently fast heartbeat can lead to problems with the heart muscle and valves and, over time, to heart failure. Metabolism speeds up and the body’s resilience falls.

That is why, with hyperthyroidism, follow these rules:

• do not ignore palpitations, shortness of breath or tremor – tell your doctor;
• avoid iodine, iodine-rich foods and iodine-containing supplements – iodine can increase hormone production further;
• do not change the dose of antithyroid medication on your own;
• do not take herbal supplements without your doctor just because they are “natural”;
• do not put off TSH, free T4 and free T3 tests and ultrasound – thyroid hormones change quickly.