Thyroid Diseases
Hyperthyroidism
Graves' disease, toxic adenoma, thyroiditis; medical, radioactive iodine, and surgical options.
What causes hyperthyroidism and what are the treatment options?
Hyperthyroidism is a state of thyroid hormone overproduction. Most common causes: Graves' disease (autoimmune, 60–80%), toxic multinodular goitre, toxic adenoma (single hyperfunctioning nodule), subacute thyroiditis (transient). Symptoms: weight loss, palpitations, tremor, heat intolerance, sweating, anxiety, insomnia. Diagnosis: suppressed TSH, elevated fT4/fT3; aetiology requires TRAb (Graves), thyroid scintigraphy (toxic adenoma vs Graves), and ultrasound. Treatment options: (1) antithyroid drugs (methimazole, propylthiouracil) — 50% remission of Graves over 18–24 months, (2) radioactive iodine — permanent solution but hypothyroidism follows, (3) surgery (total thyroidectomy) — preferred for large goitre, ophthalmopathy, pregnancy plans, or when rapid control is needed.
Treatment choice: which option for whom?
Antithyroid drugs: mild-moderate hyperthyroidism, first presentation, pregnancy or pregnancy plans (PTU in trimester 1, methimazole after), paediatric. Advantage: may preserve the gland. Disadvantage: 50% relapse, agranulocytosis risk (rare), regular monitoring.
Radioactive iodine (RAI): first choice in moderate-severe disease, drug-resistant or relapsed cases. Advantage: durable control, outpatient. Disadvantage: hypothyroidism (replacement needed), can worsen Graves ophthalmopathy, contraindicated in pregnancy.
Surgery (total thyroidectomy): compressive goitre, accompanying suspicious nodule, drug-intolerant pregnant patient, young patient declining RAI. Advantage: rapid control, definitive. Disadvantage: surgical risks (voice, parathyroid), lifelong hormone replacement.
Frequently Asked Questions
- Mostly yes. With treatment, metabolism normalises and lost weight returns in months. If excessive weight gain occurs, diet and exercise rebalance.
- Ophthalmopathy occurs in 25–30% of Graves. Smoking worsens it; cessation is mandatory. RAI can worsen ophthalmopathy; in such cases surgery may be preferred. Severe cases need ophthalmologist + endocrinologist partnership.
- Typical duration for Graves: 18–24 months. If TRAb has normalised and TSH is in range at the end, drugs are stopped; 50% achieve durable remission. Others go to RAI or surgery.
- Yes, but a 6-month wait is mandatory for full clearance. Same wait applies to men.
- A rare emergency complication of hyperthyroidism: fever >38.5°C, tachycardia >130, mental change, GI symptoms. Requires urgent admission + IV antithyroid + steroid + beta-blocker.
References
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