Hyperthyroidism Treatment Long Island

Hyperthyroidism is caused by having too much thyroid hormone circulating in the blood stream. This can be caused by an overactive thyroid, by release of thyroid hormone when the gland is being destroyed, or by taking too much thyroid medication.

Affecting one million Americans yearly, Graves’ disease is the most common cause of hyperthyroidism. The condition can also be caused by a solitary toxic nodule, a diffuse toxic nodular goiter, thyroiditis and some medications like the antiarrythmic drug amiodarone.

Symptoms of Hyperthyroidism

  • Nervousness and irritability
  • Increased resting heart rate
  • Heat intolerance and increased sweating
  • Tremor
  • Weight loss or changes in appetite
  • Frequent bowel movements
  • Thyroid enlargement
  • Thin, delicate skin and irregular fingernail and hair growth
  • Menstrual changes
  • Infertility
  • Mental changes
  • Insomnia

Although these symptoms can be seen in patients with hyperthyroidism, all of these symptoms can also be caused by other conditions. The definitive diagnosis of hyperthyroidism depends on blood tests and evaluation by your doctor.

Diagnosis of Hyperthyroidism

The diagnosis of hyperthyroidism is based both on clinical findings and on blood tests. The clinical findings of hyperthyroidism include: a rapid heart rate, arrhythmias, tremors, an enlarged thyroid, and eye abnormalities (associated with Graves’ disease). Blood tests will demonstrate a low or undetectable thyroid stimulating hormone level (TSH) and an increased thyroid hormone level (T4 and T3). Subclinical hyperthyroidism occurs when the blood tests are abnormal, but the patient does not have any symptoms.

Patients diagnosed with hyperthyroidism often undergo radioactive iodine scanning (RAI) to help determine the cause of the disease. This test can distinguish between a solitary toxic nodule, a diffuse toxic nodular goiter, subacute thyroiditis, and Graves’ disease. Knowing the underlying cause of the hyperthyroidism is essential to embarking on the proper form of treatment.

Treatment of Hyperthyroidism

Options for treatment of hyperthyroidism include antithyroid medications (Methimazole and Propylthiouracil (PTU)), radioactive iodine ablation, and surgery. The choice of treatment modality depends on the underlying cause of the hyperthyroidism and patient related factors.

  • Subacute thyroiditis often resolves on its own within a few months without specific intervention, or a short course of antithyroid medications.
  • Patient with a solitary toxic nodule will have the choice of radioactive iodine ablation or surgery to remove the half of the thyroid that contains the nodule. Usually nodules up to 3 cm in size can be well managed with radioactive iodine. With larger nodules, surgery is often the better approach.
  • Patients with a diffuse toxic multinodular goiter will also have the options of radioactive iodine versus surgery. The larger the gland, the more likely it is that surgery will be needed to remove the thyroid.
  • Patients with Graves’ disease are usually started on anti-thyroid medications, which reduce the production and release of thyroid hormone. Some patients will also need a medication to slow down the racing heart (propanolol). While many patients with Graves’ disease will enjoy a remission and can stop medication, the remission will only be durable in about 30% of patients. The remainder will need to consider a definitive treatment of the thyroid with either radioactive iodine ablation or surgery to remove the gland.

While the definitive treatment of Graves’s disease can be achieved in most patients with radioactive iodine, thyroid surgery remains an option and is most often utilized in specific circumstances which include, a very large gland, nodules that are worrisome for cancer, pregnancy or a desire to become pregnant within a year of treatment, eye disease from the Graves’ (because it can be made worse by radioactive iodine), and patient preference. The goal of both radioactive iodine ablation and surgery is to destroy or remove all of the thyroid tissue which will render the patient hypothyroid. The hypothyroidism is then managed with thyroid hormone replacement therapy which much easier to control than the hyperthyroidism that the patient presented with.