Primary care medicine

Hyperthyroidsm

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Hyperthyroidsm is a medical condition caused by excessive hormone called thyroxine in the body.

Thyroid hormone is produce by a butterfly- shaped gland on the front part of your neck called thyroid gland. Our brain produced hormone called thyroid stimulating hormone or TSH to stimulate thyroid gland to produce thyroxine hormone.

Thyroxine is one of the most important hormone in the body. It has many functions such as body metabolism and growth, regulation of body temperature, controlling heart rate, brain and bone development, ensuring proper digestive and muscle function. 

In a case of hyperthyroidsm, excessive thyroid hormone can cause various symptoms such as:

  • Weight loss despite increase appetite 
  • Heat intolerance (dislike hot conditions)
  • Increase perspiration
  • Feeling weak and lethargic
  • Protruding eyes (exopthalmos) with blurring of vision or double vision, eyes becoming red, teary and painful
  • Enlarged thyroid gland (goitre) 
  • Palpitation caused by increase heart rate, irregular heart rate (atrial fibrillation) and in severe case can cause heart failure
  • High blood pressure 
  • Fidgeting, nervousness, agitation
  • Tremors on the hands and fingers, sometime on the face, tongue, head and legs
  • Sweaty palms 
  • Menstrual issues- light, infrequent or absence of menses 
  • Gut symptom such as diarrhea 
  • Osteoporosis or declined in bone mineral density with risk of fractures 
  • Insomnia 
  • Leg swelling (pretibial myxoedema)
  • Psychiatric manifestations such as anxiety, depression, mood lability
  • Pregnancy — can affect both mother and foetus 

The most common cause of hyperthyroidsm is a condition called Graves disease. Graves disease is an autoimmune conditions where our own body system attack the thyroid gland causing increase production of thyroxine. Excessive thyroxine in the body system send a negative feedback to the brain to reduce its production of the TSH. 

After comprehensive assessment, hyperthyroidsm can be diagnose by doing blood test called thyroid function test (TFT) and thyroid antibodies levels. Your doctor may also do an ultrasound of the thyroid gland if there is an abnormal swelling on the gland

Treatment usually given by anti-thyroid medication called Carbimazole or Prophylthiouracil (PTU). It block the action of enzyme that help to produce thyroxine in the body. Several side-effects of Carbimazole includes nausea, rash, itchy skin, increased liver enzymes with yellowing of the skin and eye (jaundice) and suppression of bone marrow leading to decrease production of white blood cells that help to fight infection ('neutropenia'). This can make you very sick and vulnerable to contract serious infection. If you are experience fever, sore throat and jaundice after you started on anti-thyroid medication, seek treatment immediately. Sometime your doctor may also prescribe a medication called Beta- blocker to help reduce the heart rate and palpitation. Avoid consuming foods that contains high level of iodine such as seafoods or salt (containing iodide) as it can make hyperthyroidsm worse.

In patient who first diagnose with hypothyroidsm, first line is usually by medical therapy with anti-thyroid medication. In some instances, hyperthyroidsm can recur after the medical treatment is stopped. If patient frequently relapse, other options such as radioactive iodine and surgery will be discussed with patient for definitive treatment of hyperthyroidsm but patient can potentially render hypothyroid and needing thyroxine replacement post- procedure. There are also risks such as exposure of radioactive to others especially children (for radioactive iodine), bleeding, infection, low parathyroid level causing calcium level disturbances dan nerve injury to the muscle controlling the voice. This pros and cons will need to be discussed with patient extensively as the side-effect of the treatment can be permanent 

Severe untreated hyperthyroidsm can lead to 'thyroid storm' where patient’s heart rate, blood pressure, and body temperature can get dangerously high and without emergency treatment can often be fatal. 

If you have any of the above symptoms and concern about having hormone issue such as hyperthyroidsm, seek your doctor advise for thyroid hormone check early.