Unfortunately — as she found out at her yearly exam — the weight loss was due to hyperthyroidism.
Hyperthyroidism is the overproduction of the thyroid hormone thyroxine, or T4, says Deepika Reddy, MD, Endocrinologist. Thyroxine is the accelerator for every action in your body. An increase in T4 creates an increase in metabolism.
Symptoms of Hyperthyroidism
Because the thyroid hormone regulates metabolism, symptoms of its overproduction can be seen as:
- Weight loss
- Heat intolerance
- Protuberant eyes
- Limited range of motion in the eyes
- Warm or clammy skin
“Patients with hyperthyroidism often like it because with the increased metabolism, they’re losing weight,” says Dr. Reddy. It’s as if your body is revved up in overdrive.
Causes of Hyperthyroidism
There are a variety of reasons your thyroid may make too much thyroid hormone, Dr. Reddy says:
- Graves disease – an autoimmune disorder
- Toxic nodular goiter
- Toxic multinodular goiter
- Hashimoto’s disease
- Postpartum thyroiditis
- Subacute thyroiditis
Based on your symptoms, if your physician suspects you may have hyperthyroidism, says Dr. Reddy, your physician will run a series of blood tests to confirm the diagnosis:
- Free T4
- Radioactive iodine uptake and scan
The radioactive iodine uptake and scan can reveal whether the overproduction of thyroid hormone is due to Graves disease, toxic nodules or thyroiditis and whether it’s:
- Focused in one area
- Diffused over a larger area
Your treatment depends, Dr. Reddy says, on a variety of factors.
“If you are you are very thyroid toxic, we start with medication to suppress the production of thyroid hormone to cool the gland down and make you less symptomatic,” Dr. Reddy says.
Following that, you have two options: surgery and radioactive iodine ablation.
If you have Graves disease, Dr. Reddy says, in most cases your physician will recommend that your whole thyroid be removed.
If you have a single toxic nodule, on the other hand, your physician may recommend the removal of one lobe of your thyroid.
“Surgery is the more definitive option, but you won’t have a thyroid and you’ll have to take a replacement for the rest of your life,” Dr. Reddy says.
“The risks of this operation are injury to the nerves, vocal cords and the four parathyroid glands. The risks are institution dependent, as it depends on the experience of the surgeon. The risks here at Scott & White Healthcare are very slim, as our thyroid surgeons are fantastic,” Dr. Reddy says.
“Even subtle hyperthyroidism can have long-term consequences if you don’t treat it.”
Surgery is a good choice for people with Graves eye disease, Dr. Reddy says, as radioactive iodine ablation can worsen Graves optomopathy.
Radioactive Iodine Ablation
Treating an overproducing thyroid gland with radioactive iodine ablation is a good option for many patients, as there are minimal side effects, Dr. Reddy says.
With this treatment, you’ll receive iodine-131, which is picked by your cells and then destroys the cells that are overproducing, Dr. Reddy explains.
In some cases, however, you may need one more than one treatment to achieve stabilized thyroid hormone levels.
“It takes time, and it takes months to see the full effect of the radioactive iodine. You have to struggle with some highs and some lows while the treatment is taking effect and while we’re assessing the outcomes of whether we need to repeat a dose or whether we need to supplement with medication. But, on the other hand, it’s not a surgical intervention,” Dr. Reddy says.
In some cases, hyperthyroidism can “sort of simmer along,” Dr. Reddy says. If your elevated thyroid levels go untreated, you may develop:
- Tachycardia – increased heart rate
- Dilated cardiomyopathy
- Weakened bones and osteoporosis
- Thyroid storm
“Many patients with hyperthyroidism don’t want to be treated because they like losing weight and they don’t want to gain 20 pounds or so with treatment. We take them from being hyper-metabolic to being normal-metabolic, and they’re annoyed and disappointed with us,” says Dr. Reddy.
But the reality is in five years or so they may have an irregular heartbeat or dilated cardiomyopathy or their bones may soften even though right now they’re only losing weight, explains Dr. Reddy.
Dr. Reddy: “Even subtle hyperthyroidism can have long-term consequences if you don’t treat it.”
One caution with hyperthyroidism, Dr. Reddy points out, is that your birth-control medications will also be metabolized faster, thereby potentially rendering them ineffective. If you are using hormone therapy for birth control, please notify your doctor if you have elevated levels of thyroid hormone.