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Tuesday, February 7, 2012

Overactive Thyroid

If Symptoms Persist...
By DR. JOSE S. PUJALTE JR.

“Fear came upon me, and trembling which made all my bones to shake...” — Job 4:14 The Holy Bible, Old Testament

MANILA, Philippines — Last week we explored the sluggish world of the underactive thyroid.

Now, let’s tackle its clinical opposite – hyperthyroidism, or the overactive thyroid. This gland controls the way the body uses energy. In hyperthyroidism, the body’s metabolism revs up (imagine stepping down hard on the car’s gas pedal with the gear in neutral). You’ll feel the car shake and the engine roar but the car isn’t going anywhere. In a way, being hyperthyroid feels that way – except that it is the body’s metabolism that accelerates up to 60% of normal.

Thyroid Basics. Weighing less than an ounce, this butterfly-shaped gland is located in the neck just below the Adam’s apple. It secretes the hormones that control metabolism. T3 or triiodothyronineand T4 or thyroxine are these hormones. The thyroid has a complex interaction with the hypothalamus of the brain and the pituitary gland, a pea-sized structure known as the “master gland.” Thyroid-wise, the pituitary produces TSH or thyroid stimulating hormone. TSH is the primary controller of thyroid hormone secretion. The hypothalamus in turn controls pituitary secretion.

Hyperthyroidism. In the hyperthyroid state, the body stews in its own juices. The most common cause is Graves’ disease (an autoimmune disorder). Normally, the body’s antibodies protect against viruses and bacteria. In Graves’ disease, the body mis-identifies the thyroid as “foreign” and begins to attack it by producing antibodies.Since 85% of hyperthyroidism cases present as Graves’disease, some forget that other conditions may also result in the release of a large amount of thyroid hormones. These include non-cancerous growths of the thyroid and pituitary, inflammation of the thyroid and in some instances, over ingestion of thyroid hormones or iodine.

Signs and Symptoms. Many seasoned dieters who become hyperthyroid secretly rejoice because fictive weight loss has suddenly become massive and effortless. Sadly, other symptoms soon overwhelm the patient and any sane person will know that something isn’t right. These signs and symptoms are:

Sudden weight loss (despite usual eating habits).
Nervousness.
Restlessness.
Increased appetite.
Increased sweating.
Fatigue.
Exopthalmos (bulging eyes).
Heart palpitations (together with a bounding pulse).
Goiter (may or may not be present) – mass on the neck.
Intolerance to heat.
For women, lack of menstruation.

Diagnosis and Treatment. Initially, your favorite doctor or family medicine practitioner may screen for hyperthyroidism. Eventually, you may be referred to the endocrinologist. Laboratory findings will show increased hormone production and decreased serum TSH. In a radioactive iodine uptake test, a high radio iodine uptake in the thyroid means it is producing too much hormone. A thyroid scan also involves tracking radioactive iodine but this time an image of the thyroid is reproduced to look for inflammation or nodules (lumps).

Treatment approaches for hyperthyroidism include radioactive iodine, anti-thyroid medications such as propylthiouracil and methimazole, beta-blockers to rein in a rapid heart rate and, let’s not forget, surgery. The operation is a thyroidectomy. This removes much of the thyroid gland. A true endocrine emergency is a thyrotoxic crisis or a thyroid storm. Here the thyroid does kick up a storm – vital signs go through the roof, there’s fever and delirium, and unless treated emergently, the heart will fail.

In a way, the hyperthyroid state is easier to spot than a comparatively silent hypothyroidism. Still, recognizing it is just the first step. Taming the wild thyroid must follow.

Dr. Pujalte is an orthopedic surgeon. E-mail jspujalte@yahoo.com

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