Gaggy and Googley-eyed…or…the joys of hyperthyroidism

For a long time now since my chemotherapy ended, I have endured the effects of hypothyroidism because my poor thyroid was chemically destroyed with little hope of its recovery. The thinning hair, the dry skin, the ridiculous fatigue and the inability to lose weight have become a part of my daily routine, despite constant medication dose adjustments, doctor’s appointments, etc. Don’t get me wrong. I am extremely grateful that my liver and kidneys recovered. I can’t live without them, but this thyroid stuff is still a bummer.

Well, just when I’d settled in with those symptoms, my thyroid decided to take a turn and launch me in the opposite direction…..hyperthyroidism. Let’s talk about how it is different.

Hyperthyroidism can result from four main causes. The first is inflammation/thyroiditis of the gland due to viral infection, medication side effects, or pregnancy. The second is Grave’s disease. The third is taking too much thyroid medication. The fourth ( although very rare) ifsfrom non-cancerous growths of the thyroid or pituitary gland.

Here are the symptoms. There are so many, let’s break them down into categories.

Whole body- excess sweating, hunger, fatigue, heat intolerance, restlessness, weight loss, diarrhea, warm skin, weakness, tremor

Mood- mood swing, nervousness, panic attacks

Heart- abnormal rhythm, palpitations, tachycardia

Sleep- insomnia or difficulty falling asleep

Menstrual- irregular periods or periods that are very short and light

Behavioral- hyperactivity and irritability

Eyes- puffy eyes or protruding eyes

It all sounds fabulous doesn’t it? Nope! I was looking up risk factors for hyperthyroidism. The most common ones are family history of thyroid disease, pregnancy, chronic illness like pernicious anemia and adrenal insufficiency. I haven’t really seen my reason in many resources: the chemo destruction of the thyroid, but I can tell ya, it exists and is very difficult to treat.

All of these symptoms sound pretty annoying but not life- threatening, right? Wrong! Hyperthyroidism needs to be treated! If you have any of these symptoms, you need to see your doctor. Let’s look at what happens if hyperthyroidism goes untreated.

It can lead to weak, brittle bones and osteoporosis. Our bone strength depends on the amount of calcium and other minerals in them and too much thyroid hormone vastly decreases our calcium absorption.

Thyroid eye disease can develop. This affects the muscles and tissues around the eyes leading to bulging eyes, gritty sensation, pressure and pain in the eyes, retracted eyelids, red eyes, light sensitivity and even double vision. These untreated problems could even lead to loss of vision.

It can lead to a dermopathy that causes the skin to change color and swell. The swelling is often so significant that the skin on the shins and feet literally shins to the eye.

The most dangerous potential complication of untreated hyperthyroidism is a thyrotoxic crisis or thyroid storm. This requires immediate emergency care. Symptoms can include fever, tachycardia, nausea, vommitting, diarrhea, dehydration, and even delirium.

The first step in getting diagnosed is to go to the doctor. Get a thorough history and physical exam. The doctor will look for signs like tremor, overactive reflexes, moist skin, rapid pulse, eye changes, etc. They will examine your thyroid. labs will be ordered like T4,T3 and TSH(thyroid stimulating hormone). Make sure you are fasting when you get these tests. Also make sure you are not taking any b vitamins like biotin for at least 3 to 5 days before. If your tests are positive, you will probably get a thyroid usn.. If there are nodules, you will probably have to have a radioiodine scan.

How do you treat hyperthyroidism? Anti thyroid medicines are one option. They prevent the thyroid from making too many hormones. They usually take several weeks to work. Beta blockers are a symptom treatment option because they can bring down the rapid heart rate and tremors. They don’t do anything to the thyroid hormone levels though. Radioiodine therapy is an option. This makes the gland shrink and usually makes it underactive. This can lead tro hypothyroidism, which also needs to be treated. The most drastic option is removal of all or part of the thyroid. This is reserved as a last resort if meds , iodine etc are not an option or did not work. There are risk to this surgery which include,but are not limited to damage to the vocal cords and the parathyroid glands.

The bottom line is that hyperthyroidism needs to be taken seriously because serious complications can occur. So, if you have any of those symptoms, please seek a doctor’s care right away.

Dr. Katz