Hyperthyroid

Thyroid diseases are, arguably, among the commonest endocrine disorders worldwide. India too, is no exception. According to a projection from various studies on thyroid disease, it has been estimated that about 42 million people in India suffer from thyroid diseases.

A bit about our thyroid gland

1. Thyroid gland, being a part of the endocrine system, is the only gland that absorbs iodine from food that we eat and uses it to make two hormones (T3 and T4).
2. The crucial function of  T3 (Triiodothyronine) and T4 (Thyroxine) is to break down calories, produce energy and boosts metabolism when released into the bloodstream.
3. And it is important, two of the above shouldn’t be either too low or either too high.Above all, two glands in our brain -the hypothalamus and pituitary works a major role in maintaining the balance of T3 and T4.
4. The hypothalamus produces TSH Releasing Hormone (TRH) that signals the pituitary to tell the thyroid gland to produce more or less of T3 and T4 by either increasing or decreasing the release of a hormone called thyroid stimulating hormone (TSH).

Symptoms of hyperthyroidism can vary from person to person and may include:

• nervousness or irritability
• fatigue or muscle weakness
• trouble tolerating heat
• trouble sleeping
• shaky hands
• rapid and irregular heartbeat
• frequent bowel movements or diarrhoea
• weight loss
• mood swings
• Sensitivity to heat
• Changes in menstrual cycle
• Goitre (enlarged thyroid gland)

Grave’s disease, a common form of hyperthyroidism can affect eyes and vision leading to :

• Bulging of the eyes
• Sensitivity to light
• Double vision
• Pain or pressure in the eyes
• Redness or inflammation in and around the eyes

• Thyroid nodules: are abnormal overgrowth of tissue in the thyroid gland that are most often benign—but may be cancerous in some people.  The tissue in the nodule makes too much of T3 and T4 hormones leading to overactive thyroid.
• Thyroiditis: is inflammation of your thyroid that causes stored thyroid hormone to leak out of your thyroid gland. The hyperthyroidism may last for up to 3 months, after which your thyroid may become under active leading to hypothyroidism.
• Excess iodine intake can lead to overactive thyroid.  Excess iodine can be through high intake of seaweed supplements, some medicines or cough syrup that has high amount of iodine.
• Excess thyroid hormone medication: if you are taking medication on a regular basis then it needs to be checked periodically at least once in a year to regulate the dosage.  Excess can lead to hyperthyroidism.
• Grave’s disease: It is an autoimmune disorder that causes hyperthyroidism, or overactive thyroid. With this disease, your immune system attacks the thyroid and causes it to make more thyroid hormone than your body needs.

Risk Factors

• Women are more prone than men to develop hyperthyroidism
• If you have a family history of thyroid disease
• If you are older than 60 years
• If you have other health problems like pernicious anemia (Vit B12 deficiency) or type 1 diabetes.
• Primary adrenal insufficiency, a hormonal disorder also called addison's diease. Here the adrenal gland does not make sufficient cortisol and aldosterole which can affect the thyroid gland.

Diagnosis is done using:

Medical history and physical examination - Based on the symptoms and on the physical examination of pulse or tremors in hand

Blood tests

Blood tests to measure the levels of thyroxine and TSH.  If the TSH is low or non-existent and there are high levels of thyroxine, it indicates an overactive thyroid.  The tests are important in the cases where there are no classic signs or symptoms seen.

Radio iodine uptake test

For this test, you take a small, oral dose of radioactive iodine (radio iodine) to see how much will collect in your thyroid gland. A high uptake of radio iodine indicates your thyroid gland is producing too much thyroxine. The most likely cause is either Graves' disease or hyper functioning thyroid nodules. 

If you have hyperthyroidism and your radio iodine uptake is low, this indicates that the thyroxine stored in the gland is leaking into the bloodstream, which may mean you have thyroiditis.

Thyroid scan

During this test, you'll have a radioactive isotope injected into the vein on the inside of your elbow or sometimes into a vein in your hand and observe the image of your thyroid gland on a computer screen. This test shows how iodine collects in your thyroid.

Thyroid ultrasound

This test uses high-frequency sound waves to produce images of the thyroid. Ultrasound may be better at detecting thyroid nodules than other tests, and there's no exposure to any radiation.

Untreated hyperthyroid can lead to a condition called thyroid storm. During thyroid storm, an individual's heart rate, blood pressure, and body temperature can soar to dangerously high levels. Treatment options - depends on the cause and the severity of the disease

• Anti-thyroid medications

These medications gradually reduce symptoms of hyperthyroidism by preventing your thyroid gland from producing excess amounts of hormones.

• Radio iodine therapy

In radio iodine therapy, you take radioactive iodine-131 by mouth as a capsule or liquid. The radioactive iodine slowly destroys the cells of the thyroid gland that produce thyroid hormone without affecting other body tissues

• Thyroid surgery

Only used to treat people with large goiters or pregnant women who cannot take anti thyroid medicines.

• Diet and lifestyle management

Do’s

• Include non-iodised salt - excess of iodine can worsen hyperthyroidism.  Also include foods low in iodine like oats, unfortified cereals and drinks
• Include cruciferous vegetables - help to reduce the amount of hormones produced by the thyroid gland.  Cruciferous foods include broccoli, cauliflower, cabbage, kale etc
• Include Calcium and Vitamin D rich food - hyperthyroid interferes with calcium absorption eventually leading to osteoporosis.  Include food rich in calcium like dairy products, dark green leafy vegetables, unsalted nuts, salmon, fatty fish, fortified cereals
• Zinc and selenium - are required for good immune system and maintain healthy thyroid.  Available from foods such as cocoa powder, pumpkin seeds, dry fruits, mushrooms, chickpeas, beef, tea and so on.
• Omega 3-fatty acids - help to reduce inflammation and balance the thyroid hormones e.g. olive oil, flax seeds
• High protein diet - since weight loss is a common symptom in hyperthyroid, eat enough proteins to maintain the muscle mass and weight.  Include dairy, nuts, pulses and whole grain cereals and millets.
• Exercise regularly - help in maintaining bone density, muscle mass and cardiovascular health.
• Yoga and meditation - help in relieving stress which has been a contributing factor in the Grave’s disease.

Don’ts

• Include supplements which are rich in iodine, read the labels before purchasing any ready to eat foods.
• Include medications and cough syrup with iodine
• Nitrates cause the thyroid gland to absorb more iodine.  Some foods have naturally occurring nitrates like processed meats, turnips, fennel, leeks, beets, dill, pumpkin.  Restrict the use of these foods.
• Avoid smoking

Treating the gland so that it starts making its own hormones and regulating them

 Exercise - Bhramari Pranayama helps in stimulating the thyroid gland.

With the increase in the incidence of thyroid related problems, there is a need to find out the root cause of thyroid issues, address them at an early stage with proper lifestyle management and complimentary ayurvedic treatment options. By taking the right preventive/corrective measures it is possible to prevent the disease or manage it effectively.