About Overactive Thyroid Gland

Also known as overactive thyroid gland, Hyperthyroidism is due to excess of circulating free thyroxine (T4) or free triiodothyronine (T3), or both

. There several causes for Hyperthyroidism which include Graves' disease (the most common etiology with 70-80%), Toxic thyroid adenoma, and Toxic multinodular goiter. Some times production of excess thyroid hormone from pills may also lead to hyperthyroidism. Amiodarone, a heart medication, will also result in hyperthyroidism.

The causes of hyperthyroxinemia (high blood levels of thyroid hormones) should not to be confused with true hyperthyroidism and include subacute and other forms of thyroiditis (inflammation). Thyrotoxicosis caused by hyperthyroxinemia may occur in both hyperthyroidism and thyroiditis. When it causes acutely increased metabolism, it is sometimes called "thyroid storm".

Signs and symptoms

The symptoms include weight loss followed by strong appetite, fatigue, unable to tolerate heat, hyperactivity, polyuria, irritability, lethargy, depression, and sweating. Some times patients may have palpitations and arrhythmias, vomiting, loss of libido, shortness of breath (dyspnea), nausea, and diarrhoea. These symptoms may not be present in the elderly and they may present only with fatigue and weight loss, which leads to apathetic hyperthyroidism.

Neurological manifestations are tremor, chorea, myopathy, and periodic paralysis. Stroke of cardioembolic origin due to coexisting atrial fibrillation may be mentioned as one of the most serious complications of hyperthyroidism.

In respect of other autoimmune disorders associated with thyrotoxicosis, a relationship between myasthenia gravis and thyroid disease has been well recognized. In this condition, the thyroid disease is often an autoimmune one. Almost 5% of patients with myasthenia gravis also have hyperthyroidism. Reports indicate that thyrotoxicosis is pseudotumor cerebri, amyotrophic lateral sclerosis and a Guillain-Barr-like syndrome.

Minor ocular signs, present in any type of hyperthyroidism, are eyelid retraction and lid-lag. It is due to the thyroid hormone's exacerbation of the action of norepinephrine. In hyperthyroid stare, the eyelids are retracted upward more than normal. In lid-lag, when the patient tries to track an object downward with their eyes, the eyelid fails to follow the downward moving iris, and the same type of upper globe exposure which is seen with lid retraction occurs, temporarily. With treatment of the hyperthyroidism, these signs will disappear.

by: Simon J Pearson

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