Hyperthyroidism

anxious womanFeeling Anxious? It Could Be Your Thyroid

Did you know that hyperthyroid patients are more prone to anxiety? I’ve seen many hyperthyroids over the years, and have come to recognize them. ere are some of the main points I’ve found in a person with an overactive thyroid gland:

  • The person is often on the skinny or slim side.
  • The person finds it hard to relax and is always ‘on the go’
  • Have lost weight recently, coinciding with your anxiety. This is a KEY symptom.
  • Palpitations, rapid heart beating, worse on rest or in evening in bed. Another KEY.
  • Can lose weight in spite of eating plenty food. Every women’s dream, not for some.
  • Anxiety overload, this person can literally worry themselves sick.
  • May drive their partner or friend crazy with their anxiety or obsessive thoughts.
  • Clean freaks are sometimes hyperthyroids.
  • Obsessive compulsive patients are sometimes hyperthyroids.
  • Everything is done FAST and done NOW! KEY.
  • Person may have list of dozens of tasks to complete and literally be a ‘workaholic’.
  • Do they ever sit down? Not really… They just keep on working!
  • Exercise freaks. These folks may exercise a lot, and when they do it’s at top speed!

When you are a hyperthyroid, your medical doctor may just see you as an anxious patient and give you some Xanax or Valium. If you can relate quite well to my list above, forget your doctor’s ‘professional’ opinion – make sure you get your blood levels checked of the hormones T4, T3 and TSH. If you have any swellings in your neck, or feel like there is a lump in your throat – make sure you get your thyroid antibody levels (bloodtest) done as well.

What is the Thyroid Gland?

The thyroid gland is a small organ in the neck, just below the Adam’s apple. Its job is to make a chemical called a hormone. The thyroid hormone is named thyroxine. A normal amount of thyroxine is required for normal physical and mental development. For this reason all babies in New Zealand are screened at birth for the presence of possible thyroid hormone deficiency.
In adults, thyroxine keeps cells and tissues working at just the right metabolic rate. Too much thyroxine put out by an overactive thyroid causes an illness with a high metabolic rate called hyperthyroidism. Too little thyroxine from an underactive gland causes an illness with a low metabolic rate called hypothyroidism.

Goitre is the name given to a visible swelling of the thyroid gland in the neck. The goitre is usually normally active. That is, the thyroxine level in the blood is normal and the metabolic rate is normal. Most goitres cause no general symptoms and can often by ignored. Some people with a goitre may be advised to have simple diagnostic tests to find out exactly what kind of goitre it is and to test for the unlikely possibility of a low-grade cancer. Fortunately cancer of the thyroid is very rare. When it does occur it is nearly always low grade, can be removed by surgery, and has a much better outlook than most other types of cancer.

Virtually all forms of thyroid disease can be easily treated resulting in good health. If left untreated, however, underactive or overactive glands can cause years of severe ill health or even death. After the initial assessment you may be asked to return to the clinic for follow-up in conjunction with your own doctor.

Hyperthyroidism Means An Over Active Thyroid Gland

The exact cause of an overactive thyroid is unknown – but if you want my opinion after seeing patients for twenty years I would say that the personality has a lot to do with it. Hyperthyroidism can be inherited, and indeed it often is in many cases. The patient may well have had a mother, an aunt or a close or distant relation who had an overactive thyroid gland. Hyperthyroidism can occur for many reasons, and I wonder whether the over activity of the gland has caused the patient to become anxious, or whether the patient’s inherent anxiety caused the thyroid itself to become overactive.

Is There … No Known Cause For Hyperthyroidism?

According to the medical profession, the exact cause of an overactive thyroid is unknown. There is always a cause, it’s just that not many people are prepared to look long and hard enough into each case of auto-immune illness like overactive thyroid to find it.

The most common form of hyperthyroidism results from unusual antibody levels circulating in the blood stream which stimulate the thyroid (Grave’s Disease). Over activity is not caused by stress or changes in the diet. It may wax and wane in an individual over a period of years. Women are more often affected than men and thyrotoxicosis may appear for the first time three to six months after pregnancy.

It is surprising how many hyperthyroid patients I do see in my clinic from time to time, there are plenty of these patients out there. When it comes to thyroid disorders, most all the attention is focused on the UNDER activity of this vitally important gland, but what about the many patients who have OVER activity of the thyroid gland?

Hyperthyroidism affects different people in different ways. Many experience weight loss (despite increased appetite), tiredness, nervous symptoms and a dislike of hot weather. Shakiness of the hands and awareness of a rapid heart beat and difficulty sleeping are also common. Hyperthyroidism is a prolonged illness which, if untreated, can have severe consequences. Everyone who has it needs treatment. Careful supervision by a doctor is also required, usually for many years.

I’ve always spent time in the clinic with a hyperthyroid patient, encouraging them to s l o w down a little. To take their time when walking, talking, exercising, eating, and going about their every day life. This is quite difficult for the average hyperthyroid, because they tend to see the world a little different from you or me. My mother was hyperthyroid, and once you live with a person with this hyperactive health problem you sure get to understand what is going on. The average hyperthyroid is always on the go, finding it difficult to relax, ready to jump up at a moment’s notice to complete a task.

The Pick-Axe

The hypothalamus is a part of your brain who helps connect the way you think and feel to your hormone system. This way, the way you think and feel on a minute to minute basis affects the hypothalamus, which in turn stimulates the pituitary gland. The pituitary is called the master gland or the “conductor” of the body’s hormonal orchestra.  The pituitary is the size of a small walnut, but like the sun in our universe, it is critical to ensure that life on Earth is possible. The pituitary in turn releases TSH (thyroid stimulating hormone) which stimulates your thyroid into action. With extreme Swisse clock like accurate precision, the hormonal control of your hypothalamus – pituitary – thyroid feedback loop works 24 hours a day, seven days a week. To interfere with this precision with drug based hormones like Carbimazole or Thyroxine, is to work on a fine piece of Swisse jewelery with a pick axe. This is how an enlightened endocrinologist explained hormone therapy to me a few years ago, and I’ll never forget the analogy – the pick axe.

It is believed that the common form of hyperthyroidism results from unusual antibodies circulating in the blood stream which stimulate the thyroid(Grave’s Disease). Overactivity is deemed “not caused by stress or changes in the diet”, I have seen otherwise. It may wax and wane in an individual over a period of years. Women are more often affected than men and thyrotoxicosis may appear for the first time three to six months after pregnancy.
I have seen patients develop hyperthyroidism and with a turnaround in diet and particularly in lifestyle they became euthyroid again. (“well” thyroid). It not only happened to me, it has happened to many patients I have known, but it is NOT an easy task for some and drugs such as Carbimazole can be used effectively as a stop gap measure.

Hyperthyroidism affects different people in different ways. Many experience weight loss (despite increased appetite), tiredness, nervous symptoms and a dislike of hot weather. Shakiness of the hands, sweating (perspiration) and awareness of a rapid heart beat and difficulty sleeping are also common. Hyperthyroidism is a prolonged illness which, if untreated, can have severe consequences. Everyone who has it needs treatment. Careful supervision by a doctor is also required, usually for many years.

The Conventional Treatment of Hyperthyroidism

There are three different ways to treat an overactive thyroid:

1. Antithyroid tablets (Carbimazole, Propylthiouracil, PTU)

Once the diagnosis is made, most people are given tablets such as Carbimazole. If you take them regularly, there is a marked improvement of symptoms in most people after three to four weeks. These tablets act as a “brake” on the thyroid by blocking an enzyme in the gland. In themselves the tablets don’t make the unknown cause of hyperthyroidism go away. But by taking the tablets for one or more years, the disorder may then disappear by itself as mysteriously as it came, just with the passage of time. You will enjoy excellent health as long as the tablets are taken and the level of thyroxine is monitored by a blood-test. If you forget a dose you can ‘double-up’ with the next dose. Even after a year or more of treatment however, on stopping the tablets hyperthyroidism returns in nearly two thirds of patients, sometimes within weeks. In a minority, about one third, there may be no return of symptoms even for years.

When beginning treatment with antithyroid drugs, most people suffer no ill effects. Rarely (one in every thousand people), an important side effect may develop because of lowering of the white cell count in the blood. The symptoms of this side effect may include a sore throat, mouth ulcers or high fever and usually begin within two to six weeks of starting treatment. If you experience these effects while taking antithyroid tablets, you must contact your doctor immediately. It is stressed that this is a rare occurrence but it is important to be on the alert for it as your doctor can arrange measurement of your while blood count and the effect is rapidly reversed by stopping treatment.

A more minor but irritating side effect in about 3 percent is an itchy red skin rash which also usually develops within two to six weeks of starting the tablets. This rash sometimes goes away by itself and the tablets can be continued but if it persists, you should stop the pills and contact your doctor for further advice. Often it is possible to switch to the alternate drug. Antithyroid tablets, either carbimazole or PTU, can safely be taken under supervision during pregnancy and breast feeding. Fortunately an overactive thyroid often subsides during pregnancy, only to return 2 to 6 months after delivery.

My advice for most patients with more sever forms of hyperthyroidism is to stay on Carbimazole for some time until you are stable on the lower dosages. Many patients can eventually go onto a very low dose, and some can even discontinue here or there, although this should only be ever attempted under supervision!

2. Radioactive Iodine (Radio-iodine)

Radio-iodine treatment is often recommended once the overactive thyroid is brought under control with tablets. The great advantage of radio-iodine is that it is given at an outpatient visit, as a single tasteless drink. It has little or no side effects but “smoothly and painlessly” “cures” the thyroid condition. Radio-iodine is the most common form of treatment worldwide and has been used for 50 years. I always caution patients when considering this toxic concoction, and in most cases Carbimazole will hold the hyperthyroid condition at bay. If I have an “extreme” patient who cannot be controlled by Carbimazole or natural treatment recommendation, in some (I’ve only ever seen one in the twenty years I’ve treated patients) cases this extreme form of therapy may actually be required.

Naturally, none of us likes the idea of taking in radioactive substances unless it is absolutely necessary. In the case of radio-iodine given under a doctor’s prescription, there is “no cause for alarm” you will be told. The radiation dose is concentrated in the thyroid – other parts of your body receive very little. In fact, most of the radioactivity is excreted in the urine! Glow in the dark you say. Because it is radioactive iodine, there are some precautions necessary in the first few days of treatment.

I beg to differ with the ‘scientific’ opinion, and have helped many patients avoid drinking a “radio-active” solution, in favor of taking Carbimazole. In all the years I’ve seen patients, only one lady did not respond to Carbimazole and had to resort to the radioactive solution.

Naturally, none of us likes the idea of taking in radioactive substances unless it is absolutely necessary. In the case of radioiodine given under a doctor’s prescription, the choice is yours, you don’t have to take this option if you don’t want to, so speak up!  The radiation dose you drink will become concentrated in the thyroid in order to “kill” it. Great, and because it is radioactive iodine, there are some precautions necessary in the first few days of treatment.

Radioactive iodine is certainly never given to pregnant women or children. Amazing, although doctors say this treatment is “safe”, and say the although there is no evidence of harm to family members, they still advise against “intimate or prolonged body contact for 2 to 4 days after treatment”. Babies and children in particular, are thought to be more sensitive to unnecessary exposure to radiation. Perhaps drinking something that is radioactive may not be all that safe?

The radioiodine does most of its work in destroying the activity of your thyroid gland over the first 4 to 6 weeks but continued benefits such as shrinkage and disappearance of the goitre continue for about 6 months. If you are taking Carbimazole tablets, you will be asked to stop them 5 days before therapy and restart one week afterwards and continue until your first follow-up visit. Usually you will be asked to continue monitoring blood tests at 2-4 week intervals, until the results are stable. Sometimes a second radioiodine treatment is needed in about a quarter of individuals for a “complete cure”.

What they should tell you is this, that most who drink a radioactive drink will go on to develop – hypothyroidism, that’s right, an UNDER active thyroid gland, and when this occurs you will be asked to take thyroxine tablets on a lifelong basis. Even if your thyroid gland function remains normal in the first year of treatment, a regular annual blood test of thyroid function is necessary indefinitely because an underactive thyroid can still happen many years after radioiodine treatment.

Precautions following radio-iodine treatment

Radioactive iodine is not given to pregnant women. Although there is no evidence of harm to family members, doctors advise against intimate or prolonged body contact for 2 to 4 days after treatment. Babies and children in particular, are thought to be more sensitive to unnecessary exposure to radiation.
The nature and duration of precautions will depend on the recommended dose and your family or job circumstances. More specific precautions as they apply to you will be discussed and written down by the clinic doctor.

After radio-iodine treatment

The radio-iodine does most of its work over the first 4 to 6 weeks but continued benefits such as shrinkage and disappearance of the goitre continue for about 6 months. If you are taking antithyroid tablets, you will be asked to stop them 5 days before therapy and restart one week afterwards and continue until your first follow-up visit. Usually you will be asked to continue monitoring blood tests at 2-4 week intervals, until the results are stable. Sometimes a second radioiodine treatment is needed in about a quarter of individuals for a complete cure.
An expected effect of treatment is that the thyroid gland may become underactive in as many as one half in the first year. If this occurs it will be necessary for you to take thyroxine tablets. This is a small inconvenience to ensure continued normal thyroid function but you will need to take thyroxine on a lifelong basis. At the same time, you will be discharged from the clinic to the care of your GP who will provide a three monthly prescription of thyroxine tablets and arrange an occasional blood test to ensure that your dose of thyroxine tablets is suitable.
Even if thyroid gland function remains normal in the first year of treatment, a regular annual blood test of thyroid function is necessary indefinitely because an underactive thyroid can still happen many years after radio-iodine treatment.

3. Surgery – The Knife

Rarely, neither tablet or nor radioiodine treatment is suitable and thyroid surgery may be recommended. About three quarters of the gland is removed. There are definite risks to surgery and because of the safety and simplicity of giving a radioactive drink or tablets, operations are infrequent nowadays. Surgery was the common and preferred option years ago however, and was once very commonly performed, just like tonsillectomies were in the 1950’s. You may be interested to know that the most common operation performed in New York in 1900 was to remove 12 inches from the lower part of the bowel (colon) due to a “disease called constipation”.

The very least desirable option, and although in some cases if the patient is non-responsive than in rare cases – neither tablet or nor radio-iodine treatment is suitable and thyroid surgery may be recommended. About three quarters of the gland is removed. There are definite risks to surgery and because of the safety and simplicity of radio-iodine, operations are infrequent nowadays.

Natural Solution for Hyperthyroidism

Graves_DiseaseDo you remember a British comedian called Marty Feldman? You would probably have to be a baby boomer like me, the younger generation would have never heard of Marty. Marty suffered from Grave’s disease, and his “trademark signature” would have to have been the way he would stare inappropriately at a woman’s chest, his left eye looking at her chest while his right eye would look her in the face. It made a lot of people laugh and made him a fortune. If you watch one of Marty’s comedy clips on YouTube, you will see at times that he is quite manic in his behaviour. This is Grave’s disease at it’s best. One of the most important things you can do right NOW if you have been diagnosed with Grave’s especially is to learn to slow down, be consciously aware of your speed. Even though doctors will tell you that it “makes no difference”, I’m not convinced. I have worked with many Grave’s patients over the years and can tell you this – it does.

You Will Need To Slow down!

Those diagnosed with Grave’s disease (hyperthyroidism) would do well to slow right down. I have found that in most instances, hyperthyroid patients tend to walk fast, talk fast and move quickly in general. By slowing down the rate of speech and movement, it is possible to “ease off” that accelerator pedal. A person with Grave’s disease is like a car that’s speeding out of control and the driver just keeps on stepping on that accelerator pedal. What the hyperthyroid does something, she really goes for it 100%, there are no half measures!

My mother was a typical Grave’s disease example here. When she painted her own house (at 74yrs of age) she would use a power sander and work for hours on end. Oh, did I forget to mention to you that many hyperthyroids can tend to be very independent and stubborn? They want to take control and do it their way often. This can mean they find it difficult to delegate and work too hard, overdoing things. This typically overworks the muscles and places a continual demand on the thyroid gland to continually (over) produce the thyroid hormones T4 and T3. This results in painful and at times even burning muscles. Slow down!

Slow down your rate of speech

A good thing to do is to slow down your rate of speech. I once taped a lady with Grave’s disease during the consultation and she was amazed how fast she spoke when I played the recording back. Do you talk very fast, or have found that people find it difficult to follow you in a conversation? It could be that you are talking too quickly, just s l o w down a little. By slowing your rate of speech consciously for some time it wil become a habit. This in turn will slow your mind, and ultimately help to slow that poor thyroid gland down too!

Slow down the way you walk and move about

Hyperthyroids can move really fast, they can run to the phone when it rings or push the shopping trolley very quickly through the aisles narrowly avoiding people. They find it hard generally to slow down and relax whilst they perform many actions throughout their days. Do you move quick? Then try walking in a swimming pool about waist deep, that should slow you down a little. By becoming consciously aware of how quick you get out of your car, how you answer the phone and how you exercise you may notice that the speed is all the same – rapid. Awareness is the key, just slow down a little and you will be surprised how quickly it can become a habit. All it takes is awareness. Pretend that you are watching over your own shoulder, that should help too, or have a friend or family member observe you over the period of a few days and let them give you some feedback. Remember, when are not criticising you here, just giving you some constructive feedback aimed at improving your health and wellbeing!

The Diet

Some websites and books I have found tell you to avoid certain vegetables, claiming they can “exacerbate hyperthyroidism”, and that the natural treatment of hyperthyroidism includes avoiding such vegetables. These foods include rapeseed (used to make canola oil); the Brassica vegetables (cabbage, Brussel sprouts, broccoli, Chinese vegetables such as Bok choy, etc, and cauliflower), all which contain natural goitrogens, chemicals that cause the thyroid gland to enlarge by interfering with thyroid hormone synthesis. I have found that actually including these foods in the diet can be favourable, as they inhibit and suppress thyroid hormone production. Other goitrogens include maize, kumara (sweet potato), lima beans, soy and pearl millet. Even though none of these foods has actually been proven to cause hyperthyroidism as such, some doctors still advise avoiding these foods in the natural treatment of hyperthyroidism. In my opinion, it is actually worth haing them in your diet for several months and gauge for yourself how your hyperthyroidism is responding. You be the judge, because everybody is different and people all react differently with the foods they eat.

Conclusion

My grandmother had most of her thyroid gland removed, and my mother about half of her thyroid gland. I noticed a nodule on the right side of my thyroid gland when I was forty – which completely disappeared after taking iodine. Thank goodness I didn’t live in the 1950’s – the doctors would have almost certainly removed part if not all my thyroid gland like my predecessors!  Folks, the moral of this story is this, if you DO have hyperthyroidism, find the cause. Do you have anxiety? This is a frequent cause. Has your doctor spoken to you about stress and anxiety, why not? You may get some benefit from my article entitled cultivate your calmness.

References

  1. Kittisupamongkol W. Hyperthyroidism or thyrotoxicosis? Cleve Clin J Med. Mar 2009;76(3):152.
  2. “Floyd, J.L. (2009) Thyrotoxicosis. eMedicine.”. http://emedicine.medscape.com/article/383062-overview.
  3. http://next.thyroid.org/patients/patient_brochures/hyperthyroidism.html
  4. Faculty of Medicine & Dentistry (2006). “Course-Based Physical Examination – Endocrinology — Endocrinology Objectives (Thyroid Exam)”. Undergraduate Medical Education. University of Alberta. http://www.med.ualberta.ca/education/ugme/clinicaled12/clinskills_endocrinology.cfm?yr=1
  5. http://www.medicinenet.com/script/main/art.asp?articlekey=77774
  6. http://www.endocrineweb.com/hyper2.html
  7. http://www.springerlink.com/content/t005v86023608474/fulltext.html
  8. http://jnm.snmjournals.org/cgi/content/full/43/1/77

Article written – November 2006   Last update – May 2014

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