Symptoms

Hyperthyroidism symptoms usually include palpitations, nervousness, diaphoresis, heat-intolerance, hand tremor, weight loss, frequent defecations, menstrual irregularity, and proptosis in some patients.

Causes

Hyperthyroidism can be caused by many conditions, including Graves’ disease, toxic nodular goiter, thyroiditis, drug-related causes, pregnancy-related elevated hCG levels, and TSH-secreting pituitary adenomas. Among these, Graves’ disease is the most common cause.

Diagnosis

Laboratory examinations usually show elevated thyroid hormone levels, and most patients with Graves’ disease have positive thyroid autoantibodies.

Graves’ disease

Graves’ disease is an autoimmune disorder and often has a family history. The female-to-male ratio is approximately 7:1. Currently, there are three main treatment options for hyperthyroidism:

1. Medical treatment: Antithyroid medications are used to help restore normal thyroid function. Symptoms usually improve significantly about one month after starting treatment, and thyroid hormone levels (Free T4) typically return to the normal range within 1–2 months. The duration of treatment is closely related to the recurrence rate, and therapy generally needs to be continued for 6 months to 2 years.
2. Surgical treatment: Thyroid surgery involves removing part of the thyroid gland and is generally indicated for patients with a markedly enlarged thyroid gland, coexisting thyroid nodules, poor response to medication, or severe medication-related side effects. However, as with any surgery, there are risks, including hypothyroidism, occasional hypoparathyroidism, and very rarely hoarseness due to nerve injury. In addition, a small proportion of patients may still experience recurrence several years after surgery.
3. Radioactive iodine treatment: Radioactive iodine is used to destroy thyroid tissue. In most cases, only one treatment is needed, although some patients may require two or three treatments. Several months after treatment, patients usually develop hypothyroidism, which can be managed simply with one or two thyroid hormone tablets daily. This treatment is suitable for patients who cannot be cured with medication or who experience severe medication side effects. Women receiving radioactive iodine treatment should avoid pregnancy for at least six months after treatment.

Things to be aware of when undergoing antithyroid drug treatment:

1. Prohibitions: avoid eating laver, dry laver, and seaweed; avoid drinking coffee and tea; and do not smoke.
2. If you encounter sore throat, fever, or tonsillar abscess during antithyroid drug treatment, please check the number of white blood cells and contact your primary physician once the number is less than 3,000/uL.
3. If you have pruritus or skin rash, please inform your primary care physician at the clinic and do not stop the medication by yourself.
4. If you are pregnant, please inform your primary care physician; and do not stop the medication, and increase or decrease the dosages by yourself.
5. The treatment course lasts 2 years, please be patient and cooperative with your doctor. Thyroid function follow-ups include:
   1. Measure the thyroid function before treatment.
   2. 4-6 weeks after the medication treatment, we ask patients to return to the hospital for a blood sampling follow-up check in order to adjust the dosage.
   3. Every 3-6 months, patients are asked to do a blood sampling follow-up check for medication dosage adjustment.
   4. After a 2-year course treatment, patients will be asked to draw blood samples in order to decide whether it is feasible to stop medication.

6. After stopping drug treatment, it takes minimum of 3 years to do the thyroid function follow-up check to prevent relapse. For the first year, patients are asked to do a follow-up check every 3-6 months and 6-12 month per follow-up after that.

What you should know about Graves’ Ophthalmopathy, the so-called exophthalmos:

1. Maintain euthyroid and avoid thyroid dysfunction.
2. Minimize corneal exposure and stimulation to sunlight, sandy wind, and chemicals; contact lenses are strictly inhibited. Patients should sleep with eye patch and wear sunglasses under light stimulation.
3. Cigarette smoking prohibited, and secondhand smoking included.