Hyperthyroidism Medication: Treatment Options

Hyperthyroidism is a health condition in which your thyroid produces too much of the hormone thyroxine. This can lead to some side effects, including losing weight and irregular heartbeats.

When left untreated, hyperthyroidism can lead to serious health concerns.

However, there are a variety of treatment options available to help manage hyperthyroidism. For most people, hyperthyroidism can be effectively managed with a treatment plan from your healthcare professional, likely including medication.

What does your thyroid do?

Your thyroid is a butterfly-shaped gland that is located at the front of your neck. It is responsible for producing hormones that allow other organs and systems in your body to work properly, including your metabolism, blood pressure, and body temperature.

The two main hormones that your thyroid produces are thyroxine (T4) and triiodothyronine (T3). When your thyroid produces too many or too few hormones, your normal bodily functions may be affected.

What is hyperthyroidism?

Hyperthyroidism, also known as overactive thyroid, occurs when your thyroid gland produces more of the hormone thyroxine than your body needs.

When your thyroid gland creates excess hormones, many organs and systems in your body work faster than they should, which can result in uncomfortable and even serious side effects.

Hyperthyroidism is relatively common; it affects roughly 1 out of every 100¹ people over the age of 12 in the United States. 

What are the risk factors of hyperthyroidism?

While hyperthyroidism can happen to anyone, certain factors increase your chances of developing this condition. These include:

• Being a woman

• Being over the age of 60

• Having a family history of thyroid disease

• Consuming a large number of foods that contain iodine, such as kelp

• Using products that contain nicotine

• Having been pregnant within the last six months

• Taking medications that contain iodine

• Having other health conditions, such as diabetes, anemia, or other hormonal disorders.

Symptoms of hyperthyroidism

Because hyperthyroidism can lead to symptoms that behave like other health problems, it can sometimes be a difficult condition to diagnose. Some symptoms of hyperthyroidism include:

• Increased appetite

• Losing weight without trying to, even when you eat and exercise the same as you usually do

• Irregular heartbeat

• Rapid heartbeat

• Heart palpitations

• Sweating

• Anxiety or irritability

• Shaking hands (tremor)

• Sensitivity to heat

• Menstrual changes

• More frequent bowel movements

• Insomnia or changes to your normal sleep pattern

• Muscle weakness, tenderness, or tiredness

• Brittle, fine hair

• An enlarged thyroid gland or swelling at the bottom of your neck (goiter).

What causes hyperthyroidism?

Many factors can cause your thyroid to produce too much of the T4 hormone. The most common causes include:

• Graves' disease: This is the most common cause of hyperthyroidism and is an autoimmune disorder that causes antibodies from your immune system to encourage your thyroid to produce more T4.

• Thyroiditis: For some people, the thyroid can become inflamed due to another autoimmune disorder, after giving birth, or for unknown reasons. This inflammation can lead to T4 that has been stored in your thyroid gland to leak into your bloodstream, ultimately resulting in hyperthyroidism.

• Hyperfunctioning thyroid nodules: Sometimes, benign lumps can form on your thyroid gland, called adenomas. In some people, these adenomas can block themselves off from the rest of the organ and produce too much T4. This is also referred to as Plummer's disease.

Regardless of what may be causing your hyperthyroidism, you must take the condition seriously. If left untreated, an overactive thyroid can lead to a variety of more serious health conditions, such as:

• Heart problems

• Eye problems

• Osteoporosis

• Dermopathy

• Thyrotoxic crisis.

How is hyperthyroidism diagnosed?

If you're experiencing one or more of the symptoms listed above, it's best to schedule an appointment with your healthcare provider right away.

During your appointment, you can expect them to:

• Review your medical history: Be sure to let them know about your family history, including any family members with a thyroid condition, any other health conditions you may have been diagnosed with, and any medications you're currently taking.

• Perform a physical exam: Your doctor will likely observe and feel your lower neck (where your thyroid is located), as well as your eyes, skin, and heart rate. Let them know of any other symptoms you are experiencing that they may be not aware of, such as sensitivity to heat or trouble sleeping.

• Blood tests: Your doctor will likely want to confirm your diagnosis with blood tests, that allow them to see your T4 and TSH levels. TSH is a hormone produced by your pituitary gland that signals for your thyroid to make more thyroxine. If your T4 is high or if your TSH is undetectable, you may be diagnosed with an overactive thyroid.

It's important to let your doctor know what medications you're taking before you have blood tests performed. Certain medications can alter your results, such as the supplement biotin. After you've been diagnosed with an overactive thyroid, the doctor will likely want to identify the cause. This can be done through several tests,² including:

• Ultrasound: This will give the doctor an image of your thyroid to observe its size and whether any nodules are present.

• Thyroid scan: Your healthcare provider will inject radioactive isotope into the vein of your hand or your elbow while you lay with your head stretched backward. A camera will then transfer an image of your thyroid to a computer for your doctor to observe, showing how iodine behaves in your thyroid.

• Radioiodine uptake test: You'll drink radioactive iodine, also known as radioiodine, to determine how much of it will be collected by your thyroid gland. After a set amount of time (anywhere from four to 24 hours later, or even in intervals within that time frame), your doctor will check to see how much of the iodine has been collected by your thyroid.

What are common hyperthyroidism medication options?

Fortunately, there are a variety of treatment options for people who are diagnosed with an overactive thyroid.

Your hyperthyroidism treatment will be determined by your healthcare provider based on your particular condition, including your age, overall health, the cause of your hyperthyroidism, current medications, and personal desires.

Some examples of common hyperthyroidism treatment options include:

Anti-thyroid medications

These medications work by inhibiting your thyroid from producing too many hormones. They typically begin to work within a few weeks or months, but will often need to be used for at least a year. Examples of anti-thyroid medications³ include methimazole and propylthiouracil.

These medications can come with some side effects, such as itching, joint pains, and nausea. In rare cases, both of these medications can cause liver damage over time, potentially leading to death.

They can also suppress your body from producing infection-fighting cells “white cells” so you might need regular blood tests to monitor these levels, but this is also quite rare.

Radioactive iodine

This medication is taken orally and is used to shrink your thyroid gland. While hyperthyroid symptoms typically resolve within a few months, it can take your body months to get rid of any excess radioactive iodine. In some cases, taking radioactive iodine for too long can lead to another thyroid disease: hypothyroidism.

In hypothyroidism, your thyroid gland doesn't produce enough T4, which can require you to take a synthetic thyroid hormone, such as levothyroxine, to maintain healthy thyroid levels.

Hypothyroidism often requires treatment for life. 

Thyroidectomy

Some individuals are unable to take anti-thyroid medications, such as those who are pregnant, or who aren't comfortable taking radioactive iodine. In these cases, thyroid surgery could be an option.

During a thyroidectomy, part or all of your thyroid is removed. If your entire thyroid gland is removed (or your thyroid hormones are too low after surgery), you'll need to take a daily dose of synthetic thyroid hormones, such as levothyroxine.

Surgery is not an option for everyone struggling with hyperthyroidism and comes with several risks, including damage to vocal cords or the parathyroid glands, which are four small glands behind your thyroid that control your calcium levels.

If your parathyroid glands are damaged or removed, you'll need to take medication to maintain healthy blood-calcium levels.

Beta-blockers 

These medications are usually used to treat high blood pressure, rather than hyperthyroidism. However, they can help relieve negative symptoms of an overactive thyroid, including rapid heartbeats, shaking hands, and heart palpitations. Because of this, they may be used along with another medication to help you feel better until your thyroid levels are lowered.

Beta-blockers are not for individuals with respiratory conditions, and can sometimes cause side effects, such as tiredness and/or sexual dysfunction.  

Home remedies for hyperthyroidism

It's important to follow your healthcare provider's recommendations for hyperthyroidism treatment, including taking medications as directed.

Additionally, your doctor may recommend that you make some lifestyle changes to minimize your symptoms, including:

• Limiting your consumption of iodine, which can be found in kelp, some cough syrups, and some multivitamins.

• If you have Graves' disease, keep your eyes lubricated, wear eye protection outdoors, don't smoke, and keep your head elevated while sleeping.

• Exercise regularly to maintain a strong muscle tone and a healthy cardiovascular system, especially if you have Graves' disease.

• Practice self-care and prioritize activities that help you relax. 

Are there clinically significant innovations happening in hyperthyroidism medication?

Clinical studies are being performed by a variety of healthcare professionals, including The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) to find, diagnose, treat, and improve the lives of individuals who develop hyperthyroidism.

At The NIDDK, researchers are specifically studying the natural history and genetics behind hyperthyroidism to make advancements in treatments.

Going forward, many researchers hope to learn more about what causes Graves' disease and how to treat it, so they can stop hyperthyroidism at its source.

When to speak to your doctor or endocrinologist

If you are experiencing symptoms of an overactive thyroid, it's best to schedule an appointment with your doctor. They can determine if your symptoms are caused by a thyroid condition, including Graves' disease, or some other factor.

If they do suspect that you have an overactive thyroid, they can refer you to a physician who specializes in thyroid disorders, also known as an endocrinologist.

If you are referred to an endocrinologist, it can be helpful to prepare questions for them in advance. Here are some questions to ask your endocrinologist:

• What do you suspect is the cause of my symptoms?

• What are the other possible causes?

• What tests do you recommend and why?

• Which treatment options are available and which ones do you recommend?

• Is my condition temporary or long-term?

• How will hyperthyroidism affect my other health conditions?

• What other information do I need to know?

The lowdown

Hyperthyroidism occurs when your thyroid gland produces too much thyroxine. While this usually occurs as a result of Graves' disease, it can develop as a result of other health factors as well.

Working closely with your doctor to determine a treatment plan that is catered to your specific condition and lifestyle is the best way to treat an overactive thyroid.

Common treatment options include anti-thyroid medications, radioactive iodine, and surgery. While these treatment options are all effective, they can come with side effects.

Researchers continue to study hyperthyroidism and Graves' disease, aiming to find better treatment options and ways to improve patients' quality of life.