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Hyperthyroidism

Brief Overview: According to Medline Plus, “Hyperthyroidism, or overactive thyroid, happens when your thyroid gland makes more thyroid hormones than your body needs. Your thyroid is a small, butterfly-shaped gland in the front of your neck. It makes hormones that control the way the body uses energy. These hormones affect nearly every organ in your body and control many of your body's most important functions. For example, they affect your breathing, heart rate, weight, digestion, and moods. If not treated, hyperthyroidism can cause serious problems with your heart, bones, muscles, menstrual cycle, and fertility.”

Prevalence: According to NIDDK, “About 1 out of 100 Americans ages 12 years and older have hyperthyroidism.”

Etiology: According to NIDDK, “Hyperthyroidism has several causes, including

Risk Factors:

  • Female
  • Age > 60 years old
  • Family history of thyroid disease
  • History of thyroid surgery or thyroid problems
  • Pregnancy or childbirth in the past 6 months
  • Pernicious anemia
  • Type 1 diabetes, primary adrenal insufficiency
  • Excess iodine intake
  • Smoking

Commonly Associated Conditions:

  • Atrial fibrillation, palpitations; worsening angina/heart failure in susceptible patients
  • Osteopenia/osteoporosis (long-standing untreated disease)
  • Anxiety, insomnia, tremor
  • Graves’ ophthalmopathy (eye irritation, bulging, double vision)

Common Medications:

  • Beta-blockers
  • Anti-thyroid medication – methimazole, propylthiouracil (PTU)
  • Oral radioactive iodine-131

Common Labs, Imaging, and Tests:

  • TSH, free T4, total T3
  • Thyroid antibodies
  • Radioactive iodine uptake scan
  • Thyroid ultrasound
  • Lipid panel, CMP, CBC

Common Symptoms:

  • Anxiety, emotional lability
  • Weakness
  • Tremor
  • Palpitations
  • Heat intolerance
  • Increased perspiration
  • Diarrhea
  • Eye irritation/bulging (exophthalmos in Graves’ disease)
  • Weight loss despite normal or increased appetite

Common Treatments:

  • Medication (see above)
  • Radioiodine therapy
  • Thyroid surgery
  • Treat/avoid triggers (iodine exposure), manage comorbidities (AFib, osteoporosis, etc.), and coordinate endocrinology follow-up.

Physical Findings:

  • Goiter commonly found on physical exam
  • Hyperactivity, rapid speech
  • Stare and lid lag
  • Warm, moist skim
  • Thin, fine hair
  • Tachycardia, irregularly irregular pulse
  • Tremor
  • Proximal muscle weakness
  • Hyperreflexia
  • Thyroid nodules may be found

Potential Complications and Contraindications:

  • Complications
    • Atrial fibrillation, heart failure exacerbation, angina, stroke, and other cardiac problems
    • Bone loss/osteoporosis, muscle wasting
    • Menstrual changes, fertility/pregnancy complications
    • Graves’ ophthalmopathy
    • Thyroid storm (rare, life-threatening emergency)
  • Contraindications/cautions
    • Caution with beta-blockers in asthma/COPD or severe bradycardia (provider to individualize).

General Health and Lifestyle Guidance:

  • Take medications exactly as prescribed; don’t stop antithyroid meds abruptly without guidance.
  • Avoid excess iodine supplements/“thyroid support” products unless clinician-approved.
  • Limit stimulants that worsen symptoms (high caffeine); prioritize hydration and regular meals.
  • Track heart rate; report sustained resting HR elevation, chest pain, fainting, or new irregular heartbeat. Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.  
  • Keep follow-up labs: thyroid levels are monitored and dosing is adjusted over time.

Suggested Questions to Ask Patients:

  • What symptoms are you having (palpitations, tremor, weight loss, diarrhea, heat intolerance, anxiety, insomnia)?
  • Any red flags: chest pain, shortness of breath, fainting, confusion, high fever, severe agitation?
  • Any new irregular heartbeat or history of AFib/heart disease?
  • Current meds: antithyroid medication name/dose? beta-blocker? adherence? side effects?
  • Any fever or sore throat since starting methimazole/PTU? Any jaundice/dark urine?
  • Any recent iodine exposure (CT contrast), new supplements, or “thyroid boosters”?
  • Eye symptoms (pain, double vision, bulging, gritty sensation)?

Suggested Talking Points:

  • If you develop fever/sore throat or jaundice while on antithyroid medication, seek care urgently.
  • Call 911 or go to the ER for chest pain, severe shortness of breath, fainting, confusion, or high fever—these can be signs of a dangerous complication like thyroid storm.
  • Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.  
  • Most people improve significantly with the right treatment plan and close lab monitoring.

Sources:

This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.