Hyperthyroidism

WHAT IS THE THYOID GLAND?

The thyroid gland is a butterfly-shaped
gland located in the lower front of the
neck. The job of the thyroid gland is
to make thyroid hormones. Thyroid
hormones are released into the blood
and carried to every tissue in the body.
Thyroid hormones help the body use
energy, stay warm and keep the brain,
heart, muscles, and other organs
working. In children, thyroid hormone is
necessary for normal growth.

WHAT IS HYPERTHYROIDISM?
Hyperthyroidism means that your
thyroid gland is making too much
thyroid hormone. You may also hear
the term thyrotoxicosis. This also
means there is too much thyroid
hormone in your body.

WHAT ARE THE SYMPTOMS OF

HYPERTHYROIDISM?
If there is too much thyroid hormone,
your body speeds up and this can
cause symptoms such as:
increased sweating and feeling hot
feeling like your heart is racing or is
beating irregularly
hand tremors
anxiety, nervousness, and irritability
weight loss despite normal or even
increased appetite trouble swallowing or fullness in the neck
frequent bowel movements or diarrhea increased or decreased energy level
difficulty sleeping pain behind the eyes and/or swelling or bulging of
hair loss eyes (for autoimmune thyroid dysfunction only)
changes in menstrual periods, often lighter and/or less Everyone is different and you may not have all the
frequent symptoms. Symptoms can start suddenly or come on
slowly over time.

1 AMERICAN THYROID ASSOCIATION ®

This page and its contents are Copyright © 2023
 HYPERTHYROIDISM

WHAT CAUSES HYPERTHYROIDISM? HOW IS HYPERTHYROIDISM DIAGNOSED?

Hyperthyroidism can be caused by an autoimmune If your doctor suspects that you have hyperthyroidism,
condition (Graves’ disease), inflammation of the thyroid they may:
(thyroiditis), or due to thyroid nodules making too much Perform a physical exam to:
thyroid hormone (hot nodule or toxic multinodular goiter). Examine your thyroid for enlargement or nodules.
We will briefly describe each of these but be sure to check
Look for signs of too much thyroid hormone like fast
out our other resource links.
heart rate, shakiness/tremor of the hands, warm and
GRAVES’ DISEASE: moist skin.
Graves’ disease is the most common cause of Look for signs of thyroid eye disease like eye redness,
hyperthyroidism. It is an autoimmune thyroid condition swelling, or bulging of the eyes.
caused by antibodies that stimulate all the cells in the Check your blood for the level of thyroid hormones
thyroid gland to make too much thyroid hormone. (TSH, T4 and T3) and thyroid antibody levels (Thyroid
It tends to happen more often in younger women. stimulating immunoglobulin (TSI), thyrotropin receptor
antibodies (TRAB), and/or Thyroid Peroxidase (TPO)
Autoimmune thyroid conditions like Graves’ disease
antibodies).
can run in families.
Lab test results in hyperthyroidism usually show high
If you are diagnosed with Graves’ disease, your
T4 and/or T3 and low TSH.
family members should get thyroid testing if they
develop symptoms of hyperthyroidism. Order imaging tests like thyroid ultrasound or nuclear
medicine scans which can help determine why your
Little is known about why some people in the same
thyroid is making too much thyroid hormone.
family get this disease, while others do not.
TOXIC NODULE OR TOXIC MULTI-NODULAR GOITER: SUBCLINICAL HYPERTHYROIDISM:
A toxic nodule means that there is one area of your thyroid There is a milder form of hyperthyroidism called “subclinical
(a nodule) making too much thyroid hormone (also called hyperthyroidism”. In Subclinical hyperthyroidism, the TSH is
a hot nodule). A toxic multi-nodular goiter means that there low but the T4 and T3 are normal.
are several nodules making too much thyroid hormone. Some people may have symptoms from subclinical
Overactive nodules can be seen more often in areas hyperthyroidism, but many people will not have any
where there is less iodine in the diet. symptoms at all.
THYROIDITIS: Many of the same tests that are done for hyperthyroidism
are done for subclinical hyperthyroidism as well.
Thyroiditis is due to inflammation of your thyroid gland. This
can cause the thyroid hormones inside the thyroid gland to Not all subclinical hyperthyroidism needs treatment right
leak out into the blood stream, resulting in too much thyroid away, sometimes it can be watched. You and your doctor
hormone in the body. will decide whether to treat subclinical hyperthyroidism
depending on:
Thyroiditis can be triggered by viral infections (subacute
thyroiditis), following a pregnancy (postpartum what is causing it
thyroiditis), medications, injury or trauma to the thyroid if you have symptoms
gland and other causes. your age
Hyperthyroidism due to thyroiditis is usually self-limited, whether you have other medical problems like weak
meaning that it goes away on its own after a few weeks bones or heart conditions that can be made worse by
to months . In some cases, hypothyroidism (underactive hyperthyroidism
thyroid) can occur after the hyperthyroidism stage of
thyroiditis (see thyroiditis brochure).
These are the most common causes of hyperthyroidism. To
determine which is causing your hyperthyroidism your doctor
will review your physical exam findings, labs, and imaging.

2 AMERICAN THYROID ASSOCIATION ®

This page and its contents are Copyright © 2023
 HYPERTHYROIDISM

HOW IS HYPERTHYROIDISM TREATED?

There is no single treatment that is best for all patients with
hyperthyroidism. The treatment that you and your doctor
Understanding Thyroid
decide on will take into account factors such as your age,
your symptoms, and other medical problems (ex. heart
Function Tests
disease). It also depends on the cause of hyperthyroidism
and how abnormal the tests are. You should consult with Thyroid function tests are blood tests that allow your doctors
your endocrinologist to determine your treatment plan. to understand the signals to and from the thyroid gland. The
There are several treatments that may be recommended: pituitary is the master regulator for many of the hormones in
1. BETA BLOCKERS: the body. The pituitary releases thyroid stimulating hormone
(TSH) to tell the thyroid gland what to do.
Beta blockers are medications that help control your
symptoms such as rapid heart rate, shakiness, and A higher TSH level means that your pituitary gland wants
nervousness until your thyroid hormone levels have your thyroid gland to make more thyroid hormone.
improved. A lower TSH level means your pituitary gland wants your
They do not change thyroid hormone levels. thyroid gland to make less thyroid hormone.
Beta blockers can be started even before you know the
Sometimes, the TSH level is close to zero, and that means
cause of hyperthyroidism.
there is too much thyroid hormone in your body and your
They can be used along with another treatment (see
below) to control your symptoms until your thyroid
pituitary is trying to stop your thyroid gland from making
hormone blood levels come down. more thyroid hormone. However, the conditions that
Examples of these medications may be propranolol, cause hyperthyroidism do not respond to (listen to) the
atenolol, and metoprolol. TSH signal and continue to make (keep making) too much
2. ANTITHYROID DRUGS (ATD) – METHIMAZOLE (MMI)
thyroid hormone.
AND PROPYLTHIOURACIL (PTU): The thyroid gland makes two thyroid hormones: thyroxine
ATDs work by decreasing the ability of your thyroid cells to (T4) and triiodothyronine (T3).
make new thyroid hormones. These drugs are not effective Normally, the thyroid gland makes mainly T4 and only a
for thyroiditis. small amount of T3. T4 is changed into T3 in other places in
They do not cause a permanent reduction in your the body.
thyroid hormone levels but keep the levels controlled In hyperthyroidism, the thyroid gland usually makes extra
while you are taking the medication. The dose of the
amounts of both T4 and T3 but in some cases it only makes
ATD needs to be adjusted to keep your thyroid levels in
the normal range. too much T3.
ATDs can be used long-term or can be used short-
term as a bridge to one of the permanent options
described below.
In some patients, Graves’ disease gets better while
taking ATDs and these drugs can be stopped.
Since toxic nodules do not go into remission from
treatment with ATDs, the ATD must be continued to CONDITION: NORMAL HYPERTHYROIDISM HYPOTHYROIDISM HYPOTHYROIDISM
control hyperthyroidism. PRIMARY SECONDARY
TSH: Normal Low High Low
MMI is usually preferred over PTU because of less side T4: Normal High Low Low
effects, with certain exceptions such as pregnancy.
Extra precautions are needed if these medications are
used in pregnancy. If you find out you are pregnant,
you should contact your doctor immediately. A change
in medications is sometimes necessary.

3 AMERICAN THYROID ASSOCIATION ®

This page and its contents are Copyright © 2023
 HYPERTHYROIDISM

ANTITHYROID DRUGS (ATD) – METHIMAZOLE (MMI) Once you develop hypothyroidism, you will need to
AND PROPYLTHIOURACIL (PTU) – continued take thyroid hormone replacement every day for the
Here are the important side effects to know about: rest of your life (see Hypothyroidism brochure).
Almost all patients are treated with a single dose
Red skin rash or hives - if this happens, you should
of radioactive iodine, but about 10% of people may
contact your doctor immediately to decide on the next
need a second dose.
steps.
Safety. Radioactive iodine treatment is very safe and has
Liver injury (rare) – if you notice yellowing of your
been used to treat hyperthyroidism for many decades.
eyes or skin, itching, or dark urine you should
contact your doctor immediately as you may need to Radioactive iodine leaves the body through different
stop the medication. body fluids like urine and saliva. Therefore, you
will be given precautions for activities like not
Low white blood cells (rare) – this is called
sharing silverware, cleaning up in the bathroom,
agranulocytosis and can become a life-threatening
and avoiding (or reducing) contact with others,
problem.
particularly pregnant women and young children
If you develop a fever or severe sore throat while (see Radioactive Iodine brochure).
taking this medication, you should seek medical
Radioactive iodine should not be used if you are
care immediately to get a complete blood count
pregnant or breastfeeding.
(CBC) checked and not take any more doses
of the medication until you are cleared by your Treatment with radioactive iodine can make Thyroid
doctor to restart the medication. Eye Disease (TED) get worse. If you have TED, your
doctor can help you decide about RAI treatment.
It is very important to discuss any side effects with
the clinician who is treating your hyperthyroidism. 4 SURGERY:
3. RADIOACTIVE IODINE (RAI): Hyperthyroidism can be cured by surgical removal of the
overactive thyroid gland or nodules.
Radioactive iodine works by destroying the thyroid cells that
are making thyroid hormones. This treatment works for Graves’ The entire thyroid is removed for Graves’ disease.
disease and toxic nodules but is not effective in thyroiditis. Only half of the thyroid may be removed in certain toxic
nodules.
The RAI treatment is based on how the thyroid gland
uses iodine to make thyroid hormone: Hyperthyroidism must be controlled prior to surgery with
ATDs, beta blockers, or other medications. If you have
Iodine is the main ingredient the thyroid uses to
Graves’ disease you may be asked to take a special iodine
make thyroid hormones. Thyroid cells pull iodine
liquid for 7-10 days before surgery.
from the blood into the inside of the cell. Overactive
thyroid cells pull in more iodine than usual. Thyroid surgery is generally safe in the hands of an
Therefore, when a small dose of radioactive iodine experienced thyroid surgeon. It is important to choose an
is given as a tablet or liquid, it travels to the thyroid experienced surgeon who performs thyroid surgeries often
gland and is taken into the overactive thyroid cells. to decrease the risk of complications.
Over several weeks to months, the radiation Complications may include:
attached to the iodine destroys the overactive damage to your parathyroid glands. These glands are
thyroid cells. The gland or nodules usually shrink in located next to the thyroid gland and control your body’s
size and the thyroid hormone levels drop either back calcium levels. If your parathyroid glands are damaged it
to normal or to low levels (hypothyroidism). can cause problems with low calcium levels.
If you have Graves’ disease, your doctor will damage to the nerves that control your vocal cords,
choose a dose of RAI to try to shrink enough of the causing you to have a hoarse voice.
thyroid gland to cause permanent hypothyroidism. If your entire thyroid gland is removed, you will become
If you have a toxic nodule, the goal is to only hypothyroid since your body can no longer make thyroid
destroy the overactive nodule, but leave the rest of hormone. Thyroid levels are restored to normal by treatment
the thyroid functioning normally. However, some with a daily thyroid hormone replacement (see hypothyroidism
patients will still develop hypothyroidism. brochure). If only part of your thyroid is removed, you will need
After treatment, your thyroid blood tests are closely to follow with your doctor to determine if you need thyroid
monitored every 1-3 months. hormone replacement after surgery.

4 Learn More More details on this and other thyroid-related topics are available online at www.thyroid.org.
For information on thyroid patient support organizations, please visit the Patient Support Links section on the ATA patient information page
at https://www.thyroid.org/patient-thyroid-information/.