Hyperthyroidism: information & doctors

An overactive thyroid, also known as hyperthyroidism, is a pathological overproduction of hormones by the thyroid gland. This results in an oversupply of thyroid hormones in the body. This usually leads to an acceleration of the metabolism.

Here you can find out more about the causes and treatment options and find doctors for hyperthyroidism.

Definition: What is hyperthyroidism?

In medicine, hyperthyroidism is also known as hyperthyroidism. In this condition, the thyroid gland produces more thyroid hormones than the body needs.

The thyroid gland in humans is located at the front of the neck under the larynx. It produces the hormones triiodothyronine (T3) and thyroxine (T4) from iodine and protein building blocks. These thyroid hormones affect almost all organ systems in the body, especially the energy balance and the heart.

If the thyroid gland becomes hyperactive, this leads to an acceleration of the metabolism. This is noticeable through a faster pulse, sleep problems and inner restlessness. With the help of appropriate treatment, however, those affected can lead a normal life.

The frequency of hyperthyroidism varies depending on age. It is rarely seen in children and occurs more frequently with increasing age. Hyperthyroidism is the second most common thyroid disease.

Causes of hyperthyroidism

Hyperthyroidism can be caused by various factors. However, in around 95 percent of all patients, Graves' disease or thyroid autonomy are responsible for the occurrence of hyperthyroidism.

Graves' disease is also known as Basedow's disease and is an autoimmune disease. The immune system forms antibodies against its own organism, in this case against the thyroid gland. The antibodies dock onto the thyroid cells and stimulate hormone production. This leads to an excessive increase in hormone concentration and a slight enlargement of the thyroid gland.

Thyroid autonomy is when the thyroid gland produces hormones on its own, i.e. independently of the control of the pituitary gland (pituitary gland). This may involve individual thyroid gland sections, for example thyroid nodules, or even the entire thyroid gland.

In most cases, autonomy of the thyroid gland occurs due to a decades-long iodine deficiency. In the case of such a deficiency, the thyroid gland attempts to adapt by growing. This leads to goitre formation and nodular tissue changes.

Hyperthyroidism can lead to the formation of a goitre © Peakstock | AdobeStock

Other possible causes of hyperthyroidism include

• inflammation of the thyroid gland or
• hormone therapy of the thyroid gland in too high a dosage

are possible.

Symptoms of hyperthyroidism

The effects of hyperthyroidism vary greatly from person to person. The metabolism is almost always affected by the excessive concentration of thyroid hormones and runs faster.

This is noticeable through

• outbreaks of sweating,
• palpitations and
• restlessness.

Other typical symptoms include

• nervousness
• sensitivity to heat
• increased thirst
• Weight loss, although there is an increased appetite
• Diarrhea, occasionally also vomiting
• Muscle weakness and muscle pain
• hair loss
• tremors in the hands
• an increased skin temperature

Hyperthyroidism may or may not be accompanied by an enlargement of the thyroid gland. In the case of Graves' disease, there are also problems with the eyes, e.g.

• Sensitivity to light,
• lacrimation,
• seeing double vision,
• reddened eyes and
• protrusion of the eyeballs, because the antibodies mentioned above are also directed against the tissue in the eye.

Diagnosis of hyperthyroidism

The most sensitive parameter for the diagnosis of hyperthyroidism is the determination of the basal TSH level in the blood. If this is normal and the patient has no symptoms, no further tests need to be carried out.

However, further values are determined to differentiate the cause of the disease:

• If so-called thyrotropin receptor autoantibodies (TRAK) are detectable, Graves' disease is proven.
• If fT3 and fT4 are elevated but the basal TSH level is within the normal range, there may be a very rare case of "central hyperthyroidism". This can be caused by a TSH-producing pituitary adenoma, for example.

The diagnostic program for further clarification of hyperthyroidism usually also includes

• thyroid sonography(ultrasound) and
• thyroid scintigraphy(scintigraphy).

Treatment of hyperthyroidism

Hyperthyroidism is usually initially treated with medication. The so-called thyreostatics are thyroid blockers. They inhibit the excess production of hormones within the thyroid gland.

Thiamazole and carbimazole have proven to be effective. As part of the drug treatment, the doctor regularly checks the thyroid hormone levels. This also serves to detect a possible relapse (recurrence of hyperthyroidism) in good time. These checks are usually carried out by an endocrinologist (hormone specialist).

In addition, the blood count and liver values must be checked regularly during such therapy.

Drug treatment is often sufficient for Graves' disease. If this is not the case or if the hyperfunction returns after stopping the medication, a so-called definitive therapy must be carried out. This involves either radioiodine therapy (targeted destruction of the thyroid tissue using radioactive iodine) or surgery.

Which of the two methods is chosen must be carefully considered on a case-by-case basis. Factors that play a role in this decision include

• age,
• previous illnesses and
• the size of the thyroid gland

play a role.

If the patient suffers from thyroid autonomy, definitive therapy (radioiodine or surgery) is almost always recommended. Exceptions are usually very elderly patients, who can also be treated with long-term medication.

Diet is also important in the case of hyperthyroidism. If the disease was caused by iodine deficiency, this does not mean that normal thyroid function can be restored by compensating for the iodine deficiency.

On the contrary: if you already have hyperthyroidism, you should avoid taking iodine at all costs. This can lead to a worsening of the hyperthyroidism! This also applies in particular to the use of iodine-containing X-ray contrast media.