Anita(not real name), a young energetic woman, was doing her routine work in office combined with home as usual. Gradually she noticed that she had started losing weight for no apparent reason. Investigations done revealed her to be having hyperthyroidism.
Hyperthyroidism is a condition of the body where metabolism is deranged due to hyper functioning of thyroid gland producing thyroid hormones in excess. Most common cause for hyperthyroidism is Grave’s disease. It is a disease where antibodies are directed to body’s own tissues, affecting middle aged people, more women than men. Inflammatory conditions of the thyroid, i.e. thyroiditis are yet another cause for hyperthyroidism. About 7% women can develop hyperthyroidism after delivery. Drug like thyroxin (used to treat hypothyroidism), when given for long without monitoring can result in hyperthyroidism. Amiodarone a drug used for cardiac arrhythmias mimics thyroid function and can induce hyperthyroidism. Consumption of ground beef having thyroid gland crushed with it, can be a source of hyperthyroidism. Apart from this, tumors in the thyroid or pituitary gland also affect functioning of the thyroid gland causing hyperthyroidism.
Increased metabolism, typically manifests as sense of restlessness, feeling hot, palpitations, tremors, muscle twitching, muscle and joint pain. In spite of eating well the affected person tends to loose weight due to the hyper metabolic state. This is because metabolism becomes faster than the body can assimilate calories. Intestinal motility is increased causing recurrent diarrhea. All these can combine and weaken the strength of a person thus reducing his work efficiency also. There is protrusion of the eye balls with retraction of the eye lids giving an appearance of, “ big sized eyes”. Eye signs are more common with Grave’s disease. Swelling in front of neck known as goiter is present with thyroid disorders. Diffuse goiter is common with Grave’s disease, while a nodular goiter is suggestive of malignancy. Some cases of autoimmune disease may develop swelling of feet.
If the thyroid gland is much enlarged it can cause compression of the wind pipe and food pipe, resulting in breathlessness and difficulty in swallowing, thus adding on the morbidity.
In advanced cases, hyperthyroidism can lead to atrial fibrillation (chaotic excess beating of the heart) and heart failure. This happens because the heart is put under great stress. Patients may suffer from sexual impotence, excess menstrual bleeding. Some people may develop neurological dysfunction mimicking cerebral or spinal tumors. Smoking and alcohol consumption is known to aggravate the clinical problem.
In presence of a goiter or eye signs, with fast pulse and hand tremors, it is easy to diagnose hyperthyroidism. In other cases, a high index of suspicion is needed for diagnosing it. Because the patient may have no other clinical features except that of an anxiety state. A person may receive tranquilizers and sedatives with counseling for many months to years for a presumed anxiety neurosis, before the physician realizes that in fact he has hyperthyroidism.
Diagnosis of hyperthyroidism is established by doing a blood test to assess the level of thyroid hormones in the blood. Ultrasound and C.T. scans can aid in detecting mild thyroid enlargement in case of absence of a goiter. Biopsy of the thyroid gland is needed if there is a suspicion of malignancy.
Treatment is by antithyroid drugs, which suppress excess thyroid function. Surgery or radiotherapy is used for malignancy or severe cases. Surgery is followed by drugs with monitoring of thyroid functions clinically and by test. Other drugs are used to provide palliative relief to the patient depending on his problem. Caution is needed to avoid inducing hypothyroidism (deficiency of hormones) through treatment.
A healthy and disciplined life style can help in reducing the suffering due to hyperthyroidism.
Dr Rachna Pande,
Specialist, internal medicine