Dr Sylvie ROUX-GUINOT

Endocrinologie
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Hyperthyroidism (in English) - Dr Sylvie ROUX-GUINOT - Docvadis

Hyperthyroidism (in English)

An overactive thyroid caused by Graves’ disease is the most common cause of hyperthyroidism., It’s an auto-immune disease. Graves' disease is an autoimmune disorder in which antibodies produced by your immune system stimulate your thyroid to produce too much T-4.

Causes

Graves' disease, an autoimmune disorder, is the most common cause of hyperthyroidism. Graves' disease may develop at any age in both women and men. Antibodies produced by your immune system stimulate your thyroid to produce too much T-4, An antibody calledthyrotropin receptor antibody (TRAb), that mimics TSH, makes the thyroid gland produce large amounts of thyroid hormone. So, the body's metabolism goes into high gear. Heredity and psychological shocks (family, emotional, job-related) seem to play a role in determining Graves’ disease

Hyperfunctioning thyroid nodules (toxic adenoma, toxic multinodular goiter, Plummer's disease). This form of hyperthyroidism occurs when one or more adenomas of your thyroid produce too much T-4. An adenoma is a part of the gland that has walled itself off from the rest of the gland, forming noncancerous (benign) lumps that may cause an enlargement of the thyroid. This pathology is more common in the elderly people.

Symptoms associated with hyperthyroidism include  :

Signs and symptoms are typical:

  • Nervousness and irritability, feeling like crying without any reason.

  • Palpitations: Increased resting heart rate (tachycardia)

  • Sleep disturbances (including insomnia)

  • An increase in perspiration or warm, moist skin

  • Weight loss, despite normal or incresead eating habits

  • Diarrhea

  • Tremor: usually a fine trembling in your hand and fingers.

  • Fatigue, muscle weakness.

Grave’s ophtalmopathy

Sometimes an uncommon problem called Graves' ophthalmopathy may affect your eyes, especially if you smoke. In this disorder, your eyeballs protrude beyond their normal protective orbits when the tissues and muscles behind your eyes swell. This pushes the eyeballs forward so far that they actually bulge out of their orbits. This can cause the front surface of your eyeballs to become very dry. Eye problems often improve without treatment.

Signs and symptoms of Graves' ophthalmopathy include:

  • Protruding eyeballs

  • Red or swollen eyes

  • Excessive tearing or discomfort in one or both eyes

Light sensitivity, blurry or double vision, inflammation, or reduced eye movement.


Source

Tests and diagnosis

Blood tests will  confirm hyperthyroidism. Patients with hyperthyroidism will have a low TSH and a higher-than-normal T4 and/or T3 level. The level of the antibody known to cause Graves' disease is increased.

A thyroid sonography will be performed

 

Treatments and drugs
Graves’ disease 

Grave's disease generally will be treated by anti-thyroid medications.These medications gradually reduce symptoms of hyperthyroidism by preventing your thyroid gland from producing excess amounts of hormones. They should be taken for approximately 18 months, to avoid relapse.

Birth control pills will be necessary throughout the whole treatment. Hyperthyroidism during pregnancy is associated with a variety of complications, including miscarriage, pregnancy-induced hypertension, premature birth, low birth weight, intrauterine growth restrictions, stillbirth, thyroid storm, and maternal congestive heart failure.

Graves' ophthalmopathy

If Graves' disease affects your eyes (Graves' ophthalmopathy), you can manage mild signs and symptoms by avoiding wind and bright lights and using artificial tears and lubricating gels. If your symptoms are more severe, your doctor may recommend treatment with corticosteroids, such as prednisone, to reduce swelling behind your eyeballs. In some cases, a surgical procedure may be an option:

Toxic adenoma, toxic multinodular goiter 

This will be treated by

  • Radioactive Iodine. Taken by mouth, radioactive iodine is absorbed by your thyroid gland, where it causes the gland to shrink and symptoms to subside, usually within three to six months. Because this treatment causes thyroid activity to slow considerably, causing the thyroid gland to be underactive (hypothyroidism), you may eventually need to take medication every day to replace thyroxine

  • Surgery (thyroidectomy)                       

If you're pregnant or otherwise can't tolerate anti-thyroid drugs and don't want to or can't have radioactive iodine therapy, you may be a candida te for thyroid surgery, although this is an option in only a few cases.

 

Learn more:

- The Thyroid gland: its role and its problems.

- Thyroid : goitre, nodules and cancer

- Hypothyroidism

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