Hyperthyroidism

Diagnosis

To diagnose hyperthyroidism, your healthcare provider will conduct a thorough physical examination and may also order various tests. Here’s what they may do during the physical exam:

• Thyroid examination: Your provider will gently examine your thyroid gland by palpating it on the outside of your neck. They are checking for any enlargement, irregularities, or tenderness.
• Eye examination: The doctor will assess your eyes for signs of Graves’ eye disease, which can include swelling, redness, and bulging.
• Cardiac assessment: Using a stethoscope, your provider will listen to your heart to detect any rapid or irregular heartbeat, which can be associated with hyperthyroidism.
• Hand examination: You may be asked to outstretch your hands to check for any tremors. Additionally, your fingernails will be examined for any abnormalities.
• Skin evaluation: Your healthcare provider will assess your skin to determine if it feels warm and moist, as these can be indicators of hyperthyroidism.

To confirm the diagnosis of hyperthyroidism, blood tests are typically conducted:

• Blood Tests: A blood sample will be taken to measure thyroid hormone levels. In hyperthyroidism, levels of T3 and T4 are elevated, while thyroid-stimulating hormone (TSH) is low.

Additionally, imaging tests may be used to further assess your thyroid:

• Radioactive iodine uptake (RAIU) test: In this test, you’ll ingest a small, safe dose of radioactive iodine, and your thyroid’s absorption of it will be measured at different time intervals (usually at six and 24 hours). A gamma probe will then scan your neck to determine how much radioactive iodine your thyroid has absorbed. High absorption indicates an overproduction of thyroxine (T4) and is often associated with Graves’ disease or thyroid nodules.
• Thyroid scan: This test is an extension of the RAIU test. You’ll lie on a table with your head tilted back, and a special camera (gamma camera) will take images of your thyroid. The radioactive material makes parts of your thyroid appear bright on the screen, helping your provider identify lumps, nodules, inflammation, goiter, or thyroid cancer.
• Thyroid ultrasound: This non-invasive procedure uses high-frequency sound waves to create images of your thyroid. Your healthcare provider can visualize your thyroid on a screen and use this test to look for nodules.

By combining physical examination findings with blood tests and imaging, your healthcare provider can make an accurate diagnosis of hyperthyroidism and determine its underlying cause.

Treatment

Treatment Options for Hyperthyroidism

Hyperthyroidism can be managed with various treatments depending on factors like age, overall health, the underlying cause, and the severity of the condition. Personal preferences also play a role in choosing a treatment plan. Here are the available treatment options:

• Anti-thyroid medication: These drugs, such as methimazole and propylthiouracil, work by gradually reducing the production of thyroid hormones. Improvement in symptoms usually occurs within weeks to months. Treatment typically lasts for 12 to 18 months, with the possibility of discontinuing or reducing the dose if thyroid hormone levels return to normal. In some cases, anti-thyroid medication can induce long-term remission, but there’s a rare risk of serious liver damage associated with these drugs.
• Beta blockers: While not affecting thyroid hormone levels directly, beta blockers can alleviate hyperthyroidism symptoms like tremors, rapid heart rate, and palpitations. They are often prescribed to manage symptoms temporarily, especially while waiting for thyroid hormone levels to stabilize. However, they may not be suitable for individuals with asthma and can have side effects like fatigue and sexual problems.
• Radioiodine therapy: This treatment involves oral intake of radioactive iodine, which causes the thyroid gland to shrink and become underactive over time, leading to hypothyroidism. Symptoms usually subside within a few months. Lifelong thyroid hormone replacement medication is necessary after this treatment.
• Thyroidectomy: This surgical option involves the partial or complete removal of the thyroid gland and is not commonly used but may be considered during pregnancy, for those who cannot tolerate anti-thyroid medication, or for those who prefer not to undergo radioiodine therapy. Risks of thyroidectomy include damage to vocal cords and parathyroid glands, which regulate blood calcium levels. Levothyroxine medication is required for life after this surgery, and calcium supplementation may be necessary if the parathyroid glands are removed.

Treatment for thyroid eye disease

For individuals with thyroid eye disease, treatment options vary based on the severity of symptoms:

• Self-care: Mild symptoms can often be managed with self-care measures, including the use of artificial tear drops, lubricating eye gels, and avoiding wind and bright lights.
• Medication: More severe symptoms may require corticosteroids like methylprednisolone or prednisone to reduce eye swelling. Teprotumumab (Tepezza) can also be used for moderate to severe symptoms. In cases where these medications are not effective, other drugs like tocilizumab, rituximab, and mycophenolate mofetil may be considered.
• Surgery: Surgical options for thyroid eye disease include:
  • Orbital decompression surgery: This procedure involves removing the bone between the eye socket and sinuses to improve vision and create more space for the eyes. There are potential risks, including the persistence of double vision.
  • Eye muscle surgery: In cases where scar tissue has caused eye muscles to become too short, leading to double vision, surgery may be performed to reposition and lengthen the affected muscles.

The choice of treatment depends on individual circumstances and should be discussed with a healthcare provider to determine the most appropriate approach for managing hyperthyroidism and thyroid eye disease.