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May 3

Explained: What Is Hypothyroidism, Causes, Symptoms And Treatment – Indiatimes.com

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Do I have hyperthyroidism?

Is it hypothyroidism?

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These are common questions that come into our mind when we look at our thyroid reports. This topic deals with thyroid gland dysfunction especially hyperthyroidism.

Thyroid gland is a butterfly shaped gland which is present in the neck in front of the trachea (windpipe). The main function of this gland is to produce thyroid hormones which are T4 and T3. T4 hormone is produced in excess of T3, however T4 is converted to T3 at tissue levels which is more active than T4.

Thyroid hormone requires iodine, hence adequate iodine in diet is necessary to avoid diseases. Thyroid gland is in turn regulated by pituitary - master gland (present in the brain) by producing TSH hormone. If the T4 or T3 production is not sufficient then the TSH levels in the pituitary goes up. This is seen in hypothyroidism. Similarly, if T4 / T3 levels are high, the TSH level goes down which is commonly seen in hyperthyroidism.

Unsplash/Representational image

Even though both the terms hyperthyroidism and thyrotoxicosis are used interchangeably, both are not the same. Thyrotoxicosis is a lab finding where T4 & T3 are elevated and TSH levels are suppressed. This can be seen in hyperthyroidism, thyroiditis or overtreatment of hypothyroidism.

Hyperthyroidism is a condition where the thyroid gland is over functioning, thus producing increased levels of T4 and T3 hormones, followed by low TSH. In thyroiditis the thyroid hormone storage of 3-6 months is released prematurely into the bloodstream in a short time leading to a similar picture (but the gland is not hyperfunctioning). Luckily hyperthyroidism is much less common than hypothyroidism. The symptoms of thyrotoxicosis are as follows:

Unexplained weight loss

Tremors of hand

Palpitation- healing ones own heart beat

Increased frequency of stools

Generalized weakness

Muscle weakness

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Goitre (thyroid swelling)

Eye symptoms- redness, irritation, protrusion

Neck pain, fever

Thyrotoxicosis can be seen due to many conditions, which are discussed below

Graves Disease - Graves disease is an autoimmune disease in which auto-antibodies like TRAb (TSH receptor antibody) stimulate the thyroid to over function leading to goiter, high T4 and T3; low TSH. The TRab antibody also affects the eyes causing symptoms like redness, irritation, pain, protrusion and sometimes double vision.

Toxic Multinodular goiter - Subjects with long standing goiter may sometimes develop hyperthyroidism due to autonomy (loss of regulation by pituitary). Usually seen in elderly patients.

Toxic nodule with hyperthyroidism- Sometimes thyroid can have single hyperfunctioning nodule which increases thyroid hormone production. These can be diagnosed with Tc (Technetium) scan or Iodine 123 Scan. Patients respond well to radioactive iodine ablation.

Thyroiditis - Patients can have sudden release of thyroid hormone due to thyroiditis (inflammation of thyroid gland) causing sudden onset of symptoms like weight loss, tremor, palpitation, neck pain or fever. Usually seen after viral infections or after delivery (postpartum thyroiditis). Diagnosis is by combination of lab reports and clinical assessment. Patients respond well to steroids and painkillers.

Hyperemesis gravidarum - Pregnant women have increased HCG hormone levels which can stimulate the thyroid leading to transient thyrotoxicosis. Usually associated with vomiting in early pregnancy and resolves within 12 weeks of pregnancy.

Other causes - Some drugs like amiodarone, lithium, etc. can interfere with thyroid function or can interfere with the lab testing giving spurious results. Other rare causes of hyperthyroidism are TSH producing pituitary tumors and HCG producing tumors (germ cell tumors, choriocarcinoma)

Thyroid profile- TSH, T4 (total or free), T3 (total or free)

TSH receptor antibody (TRAb) - positive in Graves disease

Tc (Technetium scan) or I123 scan- Positive in Graves, toxic multinodular goiter and toxic nodule. Negative in thyroiditis

Ultrasound thyroid and FNA thyroid - in patients with nodular goiter

Anti-thyroid drugs- Methimazole, carbimazole, Propylthiouracil

Drugs to control symptoms and heart rate: Beta blockers or diltiazem

Radioactive iodine ablation- Patients with graves, toxic nodule, toxic multinodular goiter can be given radioactive Iodine which releases Gamma radiation which kills the overactive thyroid cells making the patient hypothyroid, which can be managed more easily

Surgery- in patients with large goiter patients who are not fit for anti-thyroid drugs and radioactive iodine.

Steroids + anti-inflammatory drugs for patients with thyroiditis

Patients require close follow up every 1-2 months initially to monitor symptoms and thyroid profiles. Once the initial control is achieved a longer interval can be prescribed. Some patients achieve long term remission with antithyroid drugs. However, patients advised against use of anti-thyroid drugs without supervision because complications can develop in unregulated treatment.

About the author: Dr. Shrinath P Shetty is an Endocrinologist at KMC Hospital, Mangalore. All views/opinions expressed in the article are of the author.

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Explained: What Is Hypothyroidism, Causes, Symptoms And Treatment - Indiatimes.com

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