Hyperthyroidism Treatment Overview

When to see a healthcare provider

If you have symptoms of a hyperthyroid, like unintended weight loss, tremor, heart palpitations, heat intolerance, or increased sweating, you should see a healthcare provider. You can start with your primary care provider, but you may be referred to an endocrinologist (hormone specialist).

It’s important to treat hyperthyroid disease because it can lead to serious complications, like Graves’ ophthalmopathy (an eye disorder), thinning bones (osteoporosis), muscle problems, and menstrual cycle and fertility issues. Also, if you have an irregular heartbeat from the condition, it can lead to blood clots, stroke, heart failure, and other heart-related problems.

Getting diagnosed

Hyperthyroidism is diagnosed based on your medical history, a physical exam, and a blood test that measures thyroid hormones like thyroxine and thyroid-stimulating hormone (TSH). People with an overactive thyroid have high levels of thyroxine and low levels of TSH.

To identify the cause of your hyperthyroidism, your healthcare provider may order these tests:

• Radioactive iodine uptake test. First, you take a pill that contains a very small amount of radioactive iodine and wait several hours for the thyroid to absorb the iodine. The doctor then places a device called a gamma probe over your neck (where your thyroid is located) to measure how much radioactive iodine is in the thyroid gland.
• Thyroid ultrasound. This imaging test measures the size of the thyroid gland and looks for thyroid nodules. Most thyroid nodules are harmless, but a small number may be cancerous.

What to expect from your doctor visit

Treatment of hyperthyroidism generally falls into three categories: taking medications to block the effects of thyroid hormone, destroying (“ablating”) the overactive thyroid gland with radioactive iodine, and surgically removing overactive thyroid tissue.

• There are two main prescription medications for suppressing thyroid hormone levels: methimazole (Tapazole) and propylthiouracil (PTU). While both are effective, methimazole is less likely to cause bad side effects, especially liver damage.
• You may also be prescribed beta-blocker medications to help manage the symptoms of hyperthyroidism.
• Your healthcare provider may recommend radioactive iodine ablation, which damages or destroys thyroid cells with radiation. Radioactive iodine capsules are taken for several months. As the radioactive iodine becomes concentrated in overactive thyroid cells, the cells slowly shrink and die. Any radioactive iodine that is not absorbed is flushed from the body without harming other healthy tissues. This treatment is not for women who are pregnant or breastfeeding.
• For some people, surgical removal of the thyroid gland may be recommended.
• Thyroid hormone replacement therapy is recommended if your thyroid has been removed and for some people who have received ablation therapy.

Prescription medications for hyperthyroid disease

• Antithyroid medications: methimazole (Tapazole), propylthiouracil (PTU)
• Beta blockers: propranolol (Inderal), atenolol (Tenormin), metoprolol (Lopressor, Toprol XL)
• Thyroid hormone replacement: Levothyroxine (Synthroid)

Types of providers for an overactive thyroid

• A primary care provider can diagnose the condition and prescribe medication.
• An endocrinologist specializes in hormone disorders like hyperthyroidism.
• If you need surgery, it can be done by a general surgeon, head and neck surgeon, endocrine surgeon, or ear, nose, and throat doctor (ENT).

Wellness and prevention

• Do not take thyroid hormone supplements unless recommended by your healthcare provider.
• If you have hyperthyroidism, you may need to limit eating iodine and iodine-enriched foods, like seafood (including seaweed and kelp), iodized salt, egg yolks, and dairy. Iodine is also in some medications, like cough syrups and herbal or vitamin supplements.
• Exercising most days of the week can help reduce your risk of complications from hyperthyroidism, like osteoporosis and muscle problems.
• Practice relaxation techniques, like yoga, deep breathing, or meditation. Stress can increase symptoms of hyperthyroidism, especially Graves' disease, the most common type.