Hyperthyroidism - home health advice

Overview
Definition

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.
Etiology

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.
Risk Factors

* Age between 20 and 40 years
* Stress
* Pregnancy
* In newborns, a mother with Graves' disease
* Intestinal dysbiosis
* Antibiotic overusage
* Family history

Signs and Symptoms

* 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

Differential Diagnosis

* Depression
* Anxiety
* Hyperactivity
* Neurologic disease with resultant tremor
* Heart disease
* Drugs

Diagnosis
Physical Examination

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.
Laboratory Tests

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.
Other Diagnostic Procedures

* Perform a radioactive iodine uptake test.
* Radioactive iodine uptake tests indicate the source of the overstimulation that results in the disease.
* Thyroid ultrasound

Treatment Options
Treatment Strategy

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.
Drug Therapies

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.
Surgical Procedures

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.
Complementary and Alternative Therapies

May minimize symptoms of mild thyroid dysfunction. Moderate to severe cases may need concurrent treatment with conventional therapies.
Nutrition

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.

Herbs

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 ? 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.
Physical Medicine

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.
Acupuncture

Acupuncture may help correct hormonal imbalances and address underlying deficiencies/excesses involved in hyperthyroidism.
Massage

Therapeutic massage may relieve stress and increase sense of well-being.
Patient Monitoring

Monitor patients during/after treatment. Watch for signs of hypothyroidism.
Other Considerations
Complications/Sequelae

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.
Pregnancy

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.
References

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.