Hyperthyroidism affects about 1 in 100 Americans aged 12 years and older. It’s a chronic condition that can cause complications if you don’t seek treatment. So, what is hyperthyroidism, and is there a cure?
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Hyperthyroidism is when your thyroid gland produces too many hormones. Your thyroid moderates most of your body’s processes, so an issue with your thyroid can cause a range of symptoms. An overactive thyroid is another name for hyperthyroidism.
Symptoms can be highly variable, as people respond in different ways. However, common symptoms include:
Rapid or irregular heartbeat
Nervousness and irritability
Sweating for no reason
Poor heat tolerance
More frequent bowel movements
A goiter: the thyroid gland becomes visibly enlarged at the front of the neck
Light and infrequent menstrual periods
Fragile fingernails that may separate from the nail bed
Hyperthyroidism is typically diagnosed with a blood test. A thyroid-stimulating hormone (TSH) test will show lower than normal levels if you have hyperthyroidism. If you have hypothyroidism or an underactive thyroid, it will show higher levels.
Several factors can cause hyperthyroidism, but these are the most common ones:
Graves' disease is an autoimmune disease, and it’s the most common cause of hyperthyroidism. It causes your thyroid gland to make more hormones than you need. Graves' disease is more common in women and people over 30. Risk factors include:
Family history of Graves' disease or Hashimoto's disease (an autoimmune disease that causes your thyroid gland to produce less hormones)
Other autoimmune diseases, especially type 1 diabetes and vitiligo
Graves' disease can cause heart failure, stroke, thinning bones, muscle problems, female infertility, and eye problems if left untreated. More than a third of people with Graves' disease develop Graves' ophthalmopathy, causing bulging or puffy eyes and blurred or double vision.
These are abnormal growths on or in your thyroid gland. Many of us have these, and they don't cause any problems. In some cases, thyroid nodules may produce excess hormones, resulting in hyperthyroidism. If you have elevated thyroid levels, your doctor may check your neck manually or with scans. In very rare cases, nodules are cancerous and need surgical removal. Your doctor may recommend surgery if your nodules are extremely large and affect your voice or ability to swallow. Radiofrequency ablation (RFA) can also shrink nodules.
Thyroiditis is a general term for inflammation of the thyroid gland, which can cause either high or low thyroid levels. Various kinds of thyroiditis can cause hyperthyroidism.
Thyroiditis causes include:
Pregnancy, which typically causes temporary hyperthyroidism followed by temporary hypothyroidism
Bacterial or viral infection
Medications: Interferon and amiodarone
In some cases, thyroiditis is temporary, although you may still need medication to stabilize your hormones until it resolves. Postpartum thyroiditis and painless thyroiditis usually cause hyperthyroidism for one to three months and hypothyroidism for nine to twelve months. 80% of patients return to normal.
Thyroiditis can sometimes be associated with pain in the neck and thyroid area, especially if an infection is causing it.
Excessive iodine consumption
While your thyroid needs iodine to function, too much iodine can send it into overdrive. This is common in people taking kelp seaweed supplements or consuming a lot of seaweed. Iodine is also a cough medicine ingredient.
Overdose of thyroid medication
If you’re on levothyroxine or desiccated thyroid for an underactive thyroid, you can get symptoms of hyperthyroidism if you overdose or if your dosage is too high. If you’re taking medication and get hyperthyroidism symptoms, speak to your doctor right away so they can adjust your dose.
Noncancerous tumors of the pituitary gland
This is very rare, but sometimes the problem isn't your thyroid at all. Located at the base of your brain, the pituitary gland tells your thyroid how much hormone to produce. A small tumor may cause it to create too much TSH.
For a cure, it depends on what kind of hyperthyroidism you have.
Doctors can treat all forms of hyperthyroidism. Treatment includes radioactive iodine to damage the thyroid, so it doesn't produce as much hormone or surgically removing all or part of the thyroid. These treatments are necessary with Graves' disease, and you typically have to take thyroid replacement medication for the rest of your life.
Because of that, it isn’t a cure, as you will still be managing your condition in the long term.
When can hyperthyroidism be cured?
Doctors can cure your hyperthyroidism if medication or iodine consumption is causing it. For example, if you take a kelp supplement and get hyperthyroid symptoms, stopping the supplement should normalize your thyroid function. If this happens, you should watch your iodine consumption as some people are sensitive to excess iodine.
If you have thyroiditis triggered by an infection, treating the infection often gets your thyroid back to normal. However, in some cases, the infection may damage your thyroid. Something as simple as the flu can trigger subacute thyroiditis, and it’s a common symptom of mumps.
There is no cure for Graves' disease or autoimmune thyroiditis.
There are two situations in which an overactive thyroid will go away on its own:
While this can be treated with beta-blockers during the hyperthyroid phase and levothyroxine during the hypothyroid phase, it usually goes away without treatment. In a few cases, you may have lifelong problems with underactive thyroid: this typically becomes an autoimmune condition triggered by the stress of pregnancy.
This typically follows a respiratory infection, and it usually goes away. However, it can leave some people with a permanently underactive thyroid.
Your doctor will want to monitor you to see if your thyroid levels return to normal. In most cases, your thyroid levels will normalize, and you’ll have no issues in the long term.
Sometimes, thyroiditis can be quite painful and come with a fever. If you have had it once, it may come back with future infections. Some people appear to be prone to post-infection thyroiditis.
There are three treatment options, which your doctor will discuss with you:
Two drugs can slow thyroid hormone production: propylthiouracil and methimazole. The first-line treatment is methimazole (Tapazole), which works quicker and has fewer side effects. However, propylthiouracil (PTU) is safer for pregnant people.
These medicines can sometimes clear up all symptoms (remission), although this is typically temporary. These drugs can cause rare side effects: rash, itching, hair loss, and fever. Sometimes they can reduce your white cell count and damage your liver, which is why your doctor will request routine blood tests while you are on these medications.
Anti-thyroid medication is typically not a lifelong treatment, but doctors prescribe it to people whose thyroid problems are likely to resolve. It can lessen the chance of recurrence.
Radioactive iodine treatment
This is the first-line treatment for Graves' disease and other permanent causes of thyroid hormone overproduction. You take iodine orally, and your thyroid absorbs it and destroys cells in the gland. As this treatment isn't precise, you will end up with an underactive thyroid and need lifelong hormone therapy. Levothyroxine is generally well-tolerated and has very few side effects.
Doctors typically resort to surgery if you have thyroid nodules that might be cancerous or if there is a good reason why radiation treatment would not be safe, such as if you are pregnant. Again, this leads to hypothyroidism which your doctor will treat with hormone replacement therapy.
None of these treatments are cures. One is temporary, and the other two cause permanent hypothyroidism. However, they can allow you to return to a normal life.
For Graves’ disease, one of the best ways to reduce your risk of developing the condition is to stop smoking. Cutting out cigarettes also improves remission rates¹.
Untreated hyperthyroidism can lead to a variety of complications and health problems, including:
Elevated risk of stroke
Higher risk of heart failure
Graves' ophthalmopathy, which can result in vision loss
If you’ve had radioactive iodine treatment or surgery and have an underactive thyroid, you need to take your hormone replacement medication regularly. Levothyroxine should be taken at about the same time every day on an empty stomach. You shouldn’t directly mix it with soy products, calcium supplements, and grapefruit. Setting an alarm or phone reminder is a helpful way to remember to take your medication as there are no immediate symptoms if you forget.
If your hyperthyroidism is mild and/or you are on medication, there are things you can do to live better. No, hyperthyroidism can't be “controlled” through diet and exercise, although some people may try to sell you a diet plan or similar. Don’t fall for these!
Instead, here are seven great ideas to improve your wellbeing:
Avoid iodine supplements and seaweed
Keep your iodine consumption down as it can aggravate your symptoms. If you are preparing for surgery, you may be prescribed iodine drops. If excessive iodine consumption caused your problems, you should continue to be careful. Consider switching to non-iodized table salt.
If you smoke, do your best to quit. Studies have demonstrated that smoking can prevent hyperthyroidism remission. One of the reasons smokers often have thyroid issues may be that smoking reduces your ability to metabolize selenium, which takes us to our next tip:
Talk to your doctor about supplementing selenium². Increasing selenium can improve mild to moderate Graves’ eye disease. Look for foods high in selenium.
Increase vitamin D
Supplement vitamin D if you have low levels. Many of us have a vitamin D deficiency, especially in the winter when we are not as exposed to the sun. Vitamin D deficiency can also affect your immune system.
There's some evidence in animal studies that turmeric³ could balance thyroid hormone levels. You can take a turmeric supplement or cook recipes containing the spice.
Try going gluten-free
Graves’ disease is often comorbid with celiac disease, and some studies indicate that a gluten-free diet⁴ helps with the absorption of thyroid medications.
Avoid caffeine if you have issues sleeping. Caffeine can worsen insomnia and can sometimes affect other hyperthyroid symptoms.
It's worth talking to a dietician to see if you can make simple dietary changes, especially if you are on anti-thyroid medication and hoping to go into remission.
Many forms of hyperthyroidism will either resolve on their own or with simple changes, such as reducing iodine consumption. Others need extensive treatment. Doctors cannot cure hyperthyroidism if you have Graves' disease or another form of hyperthyroidism, but they can treat and manage it.
If you have symptoms of hyperthyroidism, speak to your doctor about getting your TSH levels checked. It’s an easy way to see if your thyroid is causing your problems. Low levels of TSH are a strong indicator that you have hyperthyroidism.
Doctors can always treat hyperthyroidism, so never ignore your symptoms. Make an appointment to speak to your primary care physician if you’re concerned about any symptoms you have.