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Overview |
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Definition |
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Hyperthyroidism occurs when the thyroid gland produces excessive amounts of
thyroid hormone. The condition can take three different forms. Graves' disease
appears as a goiter in the neck along with eye and skin changes.Graves' disease
is an autoimmune condition. It stems from an antibody that stimulates the
thyroid to produce excessive amounts of thyroid hormones. In the process, the
antibody overwhelms the usual thyroid-stimulating hormone. The stimulation
causes the thyroid to grow, creating a goiter in the neck. In Graves'
ophthalmopathy, the extraocular muscles show edema, increased connective tissue
fatty infiltration, and infiltration by lymphocytes. In toxic nodular goiter,
one or more nodules in the thyroid, which are benign thyroid tumor, produce an
excess of thyroid hormone. Secondary hyperthyroidism occurs when the pituitary
gland stimulates the thyroid to overproduce thyroid hormones.
The ailment varies in severity. Most cases can be treated effectively with
medication. Surgery may be necessary if conservative treatment fails. Left
untreated, hyperthyroidism is potentially fatal. One complication, thyroid
storm, is a life-threatening emergency that requires immediate treatment. It
manifests itself as sudden, extreme overactivity of the thyroid gland, produces
fever, weakness, loss of muscle, restlessness, mood swings, confusion, altered
consciousness, and an enlarged liver with mild jaundice.
Estimates suggest that at least two million Americans, and possibly double
that number, suffer from some degree of hyperthyroidism. Thyroid problems affect
four times as many women as men, and more elderly individuals than younger
people. All types of hyperthyroidism cause the body's cells to burn fuel so
rapidly that they waste much of it in the form of heat. |
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Etiology |
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While several different factors trigger hyperthyroidism, stress is thought to
play a role in the onset of the disease. The disease appears most often in
individuals between the ages of 20 and 40. |
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Risk Factors |
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- Age between 20 and 40 years
- Stress
- Pregnancy
- In newborns, a mother with Graves' disease
- Intestinal dysbiosis
- Antibiotic overusage
- Family history
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Signs and Symptoms |
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- Tachycardia
- Tachyarhythmia/palpitations
- Bruit over thyroid gland
- Hypertension
- Swelling at the base of the neck
- Moist skin and increased perspiration
- Shakiness and tremor
- Nervousness
- Confusion
- Increased appetite accompanied by weight loss
- Difficulty sleeping
- Swollen, reddened, and bulging eyes
- Constant stare (infrequent blinking, lid lag)
- Sensitivity of eyes to light
- Occasionally, raised, thickened skin over shins, dorsum of feet,
back, hands, or even face
- In thyroid storm: fever, very rapid pulse, agitation, and possibly
delirium
- Altered menses
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Differential
Diagnosis |
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- Depression
- Anxiety
- Hyperactivity
- Neurologic disease with resultant tremor
- Heart disease
- Drugs
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Diagnosis |
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Physical Examination |
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Patient is typically restless and anxious. Look for a slight tremor when
patient sticks out tongue and extends the fingers. Examination of the thyroid
gland while the patient swallows will yield evidence of enlargement.
Auscultation may exhibit a bruit. |
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Laboratory Tests |
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Serum thyroxine (T4) assay on free T4 and the thyroid-hormone-binding ratio
give accurate assessments of the state of the thyroid. If necessary, test also
for an increase in the concentration of thyroxine and a decrease in that of
thyroid-stimulating hormone. Serum triiodothyronine (T3) assay also helps to
differentiate between Graves' disease, toxic nodular goiter, T3 toxicosis, and
secondary hyperthyroidism. |
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Other Diagnostic
Procedures |
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- Perform a radioactive iodine uptake test.
- Radioactive iodine uptake tests indicate the source of the
overstimulation that results in the disease.
- Thyroid ultrasound
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Treatment Options |
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Treatment Strategy |
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Three basic forms of treatment are available for the various manifestations
of hyperthyroidism: thyroid depressive drugs, radioactive iodine, and surgery.
Surgery is now the therapy of last resort. |
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Drug Therapies |
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Although the thyroid gland needs a small amount of iodine to function
properly, a large amount of this element prevents the gland from releasing
excess thyroid hormone. Thus, a one-time dose of radioactive iodine in liquid
form has become the most popular method of treatment. The dose depends on the
size of the thyroid and the findings of the radioactive iodine uptake test. The
health care provider must assess the effect of the initial dose after 2 to 3
months. Depending on the result, he or she should plan follow-up visits every 6
to 12 weeks. Can cause hypothyroidism and is contraindicated in pregnancy.
Alternatively, prescribe thyroid depressive drugs in tablet form.
Propylthiouracil and methimazole, the drugs most commonly used, decrease
production of thyroid hormone. Oral doses should start high; adjust the doses
downward according to the results of blood tests for the thyroid hormone.
Typical starter doses usually bring hyperthyroidism under control within 6 to 12
weeks. Larger doses can control the condition faster, but may increase risk of
adverse effects, such as allergic reactions, nausea, loss of taste and, rarely,
depressed synthesis of blood cells in the bone marrow.
Beta-blocking drugs such as propranolol help to control some of the symptoms
of hyperthyroidism, particularly in a thyroid storm. They slow heart rates,
reduce tremors, and control anxiety. However, they do not control abnormal
thyroid function. |
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Surgical Procedures |
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Suggest surgery for patients who have very large goiters, cannot receive
radioactive iodine, do not tolerate other drugs, or do not benefit from medical
treatment. The surgery involves removal of parts or most of the thyroid gland,
and permanently controls hyperthyroidism in more than 90% of patients. However,
it can lead to hypothyroidism in some patients, who must take replacement
thyroid hormone from then on. |
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Complementary and Alternative
Therapies |
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May minimize symptoms of mild thyroid dysfunction. Moderate to severe cases
may need concurrent treatment with conventional therapies. |
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Nutrition |
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Foods that depress the thyroid and should be included in the diet are
broccoli, cabbage, brussels sprouts, cauliflower, kale, spinach, turnips, soy,
beans, and mustard greens. Sorghum, flaxseed, cassava, and pulses contain
cyanogenic glycosides which depress thyroid function. Avoid refined foods, dairy
products, wheat, caffeine, and alcohol. Food allergies play a role in any
autoimmune disease and should be assessed if that is suspected.
- Essential fatty acids are anti-inflammatory and help to modulate
immune function. Take 1,000 to 1,500 mg tid.
- Bromelain (250 to 500 mg tid between meals) is a proteolytic enzyme
that reduces inflammation.
- Vitamin C (1,000 mg tid to qid) supports immune function and
decreases inflammation.
- Calcium (1,000 mg/day) and magnesium (200 to 600 mg/day) are
cofactors for many metabolic processes.
- Vitamin E (400 IU bid) can help protect the heart during periods of
tachycardia.
- Coenzyme Q10 (50 mg bid) can help protect the heart during periods of
tachycardia.
- Lithium has antithyroid properties. Doses of as little as 20 mg per
day of elemental lithium may augment other antithyroid
treatments.
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Herbs |
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Herbs are generally a safe way to strengthen and tone the body's systems.
Ascertain a diagnosis before pursuing treatment. Herbs may be used as dried
extracts (capsules, powders, teas), glycerites (glycerine extracts), or
tinctures (alcohol extracts). Unless otherwise indicated, teas should be made
with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or
flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups/day. Tinctures may be
used singly or in combination as noted.
- Bugleweed (Lycopus virginica) and lemon balm (Melissa
officinalis) help to normalize the overactive thyroid. Motherwort
(Leonurus cardiaca) may relieve heart palpitations and passionflower
(Passiflora incarnata) reduces anxiety. Combine two parts of bugleweed
with one part each of lemon balm, motherwort, and passionflower and take in
tincture form, 30 to 60 drops tid to qid.
- Quercetin (250 to 500 mg tid) is an anti-inflammatory.
- Turmeric (Curcuma longa) potentiates bromelain and should be
taken between meals, 500 mg tid.
- Milk thistle (Silibum marianum) helps the liver to provide
proper binding proteins to sequester thyroid hormone, 300 to 600 mg
tid.
- Hawthorn berry (Crataegus laevigata) helps to protect the heart
during periods of tachycardia ¼ tsp. of the solid extract, or 1,000 mg of the
herb, tid.
- Lemon balm inhibits the binding of TSH and thyroid-stimulating
antibodies to TSH receptors.
- Immune suppressing herbs such as Stephania tetranda and
Hemidesmus indicus help break the circle of cellular damage in chronic
inflammation.
- Anti-inflammatory herbs such as licorice (Glycyrrhiza glabra)
and Rehmania glutinosa are systemic anti-inflammatories and support
the adrenals as well.
Homeopathic Remedies
An experienced homeopath should assess individual constitutional types,
severity of disease, and select the correct remedy and
potency. |
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Physical Medicine |
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Ice packs to the throat will help to decrease inflammation. Castor oil packs
to the throat will also reduce inflammation. Apply oil directly to skin, cover
with a clean soft cloth (e.g., flannel) and plastic wrap. Place a heat source
over the pack. Leave in place for 30 to 60 minutes. For best results use three
consecutive days in one week. |
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Acupuncture |
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Acupuncture may help correct hormonal imbalances and address underlying
deficiencies/excesses involved in hyperthyroidism. |
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Massage |
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Therapeutic massage may relieve stress and increase sense of
well-being. |
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Patient Monitoring |
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Monitor patients during/after treatment. Watch for signs of
hypothyroidism. |
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Other
Considerations |
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Complications/Sequelae |
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Liquid radioactive iodine may have long-term effects on mortality. Patients
who experience severe weight loss/muscle wasting after treatment should follow a
diet that provides supplemental calories and protein. |
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Pregnancy |
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Thyroid testing during pregnancy may have variable and unreliable results.
Mild pathology may not be detected until after pregnancy. A thyroid storm is a
rare complication in pregnancy and may be life-threatening. Thyroid treatment in
pregnancy should be supervised by a physician. |
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References |
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Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace
Publishers; 1995:422.
Berkow R. Merck Manual. 16th ed. Whitehorse Station, NJ: The Merck
Publishing Group; 1992.
Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic
Guide to Herbal Medicines. Boston, Mass: Integrative Medicine
Communications; 1998:432.
Hoffman D. The New Holistic Herbal. New York, NY: Barnes & Noble
Books; 1995:95. |
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Copyright © 2000 Integrative Medicine
Communications This publication contains
information relating to general principles
of medical care that should not in any event be construed as specific
instructions for individual patients. The publisher does not accept any
responsibility for the accuracy of the information or the consequences arising
from the application, use, or misuse of any of the information contained herein,
including any injury and/or damage to any person or property as a matter of
product liability, negligence, or otherwise. No warranty, expressed or implied,
is made in regard to the contents of this material. No claims or endorsements
are made for any drugs or compounds currently marketed or in investigative use.
The reader is advised to check product information (including package inserts)
for changes and new information regarding dosage, precautions, warnings,
interactions, and contraindications before administering any drug, herb, or
supplement discussed herein. | |