Hyperthyroidism

Not to be confused with Hyperthyroxinemia. 1 Signs and symptoms

Hyperthyroidism, also known as over active thyroid

and hyperthyreosis, is the condition that occurs due to
excessive production of thyroid hormone by the thyroid
gland.[1] Thyrotoxicosis is the condition that occurs due
to excessive thyroid hormone of any cause and there-
fore includes hyperthyroidism.[1] Some, however, use the
terms interchangeably.[2] Signs and symptoms vary be-
tween people and may include irritability, muscle weak-
ness, sleeping problems, a fast heartbeat, poor tolerance
of heat, diarrhea, enlargement of the thyroid, and weight
loss. Symptoms are typically less in the old and dur-
ing pregnancy.[3] An uncommon complication is thyroid
storm in which an event such as an infection results in
worsening symptoms such as confusion and a high tem-
perature and often results in death.[4] The opposite is
hypothyroidism, when the thyroid gland does not make
enough thyroid hormone.[5]
Graves disease is the cause of about 50% to 80%
of case of hyperthyroidism in the United States.[3][6]
Other causes include multinodular goiter, toxic adenoma,
inammation of the thyroid, eating too much iodine, and
too much synthetic thyroid hormone.[3][4] A less com-
mon cause is a pituitary adenoma. The diagnosis may
be suspected based on signs and symptoms and then con-
rmed with blood tests. Typically blood tests show a low
Illustration depicting enlarged thyroid that may be associated with
thyroid stimulating hormone (TSH) and raised T3 or T4 . hyperthyroidism
Radioiodine uptake by the thyroid, thyroid scan, and TSI
antibodies may help determine the cause.[3] Hyperthyroidism may be asymptomatic or present with
[4]
Treatment depends partly on the cause and severity of dis- signicant symptoms. Some of the symptoms of hy-
ease. There are three main treatment options: radioiodine perthyroidism include nervousness, irritability, increased
therapy, medications, and thyroid surgery. Radioio- perspiration, heart racing, hand tremors, anxiety, di-
dine therapy involves taking iodine-131 by mouth which culty sleeping, thinning of the skin, ne brittle hair, and
is then concentrated in and destroys the thyroid over muscular weaknessespecially in the upper arms and
weeks to months. The resulting hypothyroidism is treated thighs. More frequent bowel movements may occur, but
with synthetic thyroid hormone. Medications such as diarrhea is uncommon. Weight loss, sometimes signif-
beta blockers may control the symptoms and anti-thyroid icant, may occur despite a good appetite (though 10%
medications such as methimazole may temporarily help of people with a hyperactive thyroid experience weight
[7]
people while other treatments are having eect. Surgery gain ), vomiting may occur, and, for women, menstrual
to remove the thyroid is another option. This may be ow may lighten and menstrual periods may occur less
[8]
used in those with very large thyroids or when cancer is a often, or with longer cycles than usual.
[3]
concern. In the United States hyperthyroidism aects Thyroid hormone is critical to normal function of cells.
about 1.2% of the population.[1] It occurs between two In excess, it both overstimulates metabolism and ex-
and ten times more often in women.[3] Onset is commonly acerbates the eect of the sympathetic nervous sys-
between 20 and 50 years of age.[4] Overall the disease is tem, causing speeding up of various body systems
more common in those over the age of 60 years.[3] and symptoms resembling an overdose of epinephrine
(adrenaline). These include fast heart beat and symp-
toms of palpitations, nervous system tremor such as

1
2 2 CAUSES

of the hands and anxiety symptoms, digestive system temporarily. These signs disappear with treatment of the
hypermotility, unintended weight loss, and (in lipid hyperthyroidism.
panel blood tests) a lower and sometimes unusually low Neither of these ocular signs should be confused with
serum cholesterol. exophthalmos (protrusion of the eyeball), which occurs
Major clinical signs include weight loss (often accom- specically and uniquely in hyperthyroidism caused by
panied by an increased appetite), anxiety, intolerance Graves disease (note that not all exophthalmos is caused
to heat, hair loss (especially of the outer third of the by Graves disease, but when present with hyperthy-
eyebrows), muscle aches, weakness, fatigue, hyperac- roidism is diagnostic of Graves disease). This forward
tivity, irritability, high blood sugar, excessive urination, protrusion of the eyes is due to immune-mediated inam-
excessive thirst, delirium, tremor, pretibial myxedema mation in the retro-orbital (eye socket) fat. Exophthal-
(in Graves disease), emotional lability, and sweating. mos, when present, may exacerbate hyperthyroid lid-lag
Panic attacks, inability to concentrate, and memory prob- and stare.[11]
lems may also occur. Psychosis and paranoia, com-
mon during thyroid storm, are rare with milder hyperthy-
roidism. Many persons will experience complete remis- 1.1 Thyroid storm
sion of symptoms 1 to 2 months after a euthyroid state
is obtained, with a marked reduction in anxiety, sense Main article: Thyroid storm
of exhaustion, irritability, and depression. Some indi-
viduals may have an increased rate of anxiety or per-
Thyroid storm is a severe form of thyrotoxicosis char-
sistence of aective and cognitive symptoms for sev-
acterized by rapid and often irregular heart beat, high
eral months to up to 10 years after a euthyroid state is
temperature, vomiting, diarrhea, and mental agitation.
established.[9] In addition, those with hyperthyroidism
Symptoms may be unusual in the young, old, or
may present with a variety of physical symptoms such as
pregnant.[4] It is a medical emergency and requires hospi-
palpitations and abnormal heart rhythms (the notable ones
tal care to control the symptoms rapidly. Even with treat-
being atrial brillation), shortness of breath (dyspnea),
ment, death occurs in 20% to 50%.[4]
loss of libido, amenorrhea, nausea, vomiting, diarrhea,
gynecomastia and feminization.[10] Long term untreated
hyperthyroidism can lead to osteoporosis. These classical
symptoms may not be present often in the elderly.
1.2 Hypothyroidism
Neurological manifestations can include tremors, chorea, Hyperthyroidism due to certain types of thyroiditis can
myopathy, and in some susceptible individuals (in par- eventually lead to hypothyroidism (a lack of thyroid
ticular of Asian descent) periodic paralysis. An associ- hormone), as the thyroid gland is damaged. Also,
ation between thyroid disease and myasthenia gravis has radioiodine treatment of Graves disease often eventually
been recognized. The thyroid disease, in this condition, leads to hypothyroidism. Such hypothyroidism may be
is autoimmune in nature and approximately 5% of pa- treated by regular thyroid hormone testing and oral thy-
tients with myasthenia gravis also have hyperthyroidism. roid hormone supplementation.
Myasthenia gravis rarely improves after thyroid treatment
and the relationship between the two entities is not well
understood.
2 Causes
In Graves disease, ophthalmopathy may cause the eyes
to look enlarged because the eye muscles swell and push
There are several causes of hyperthyroidism. Most of-
the eye forward. Sometimes, one or both eyes may bulge.
ten, the entire gland is overproducing thyroid hormone.
Some have swelling of the front of the neck from an en-
[8] Less commonly, a single nodule is responsible for the
larged thyroid gland (a goiter).
excess hormone secretion, called a hot nodule. Thy-
Minor ocular (eye) signs, which may be present in any roiditis (inammation of the thyroid) can also cause
type of hyperthyroidism, are eyelid retraction (stare), hyperthyroidism.[12] Functional thyroid tissue producing
extra-ocular muscle weakness, and lid-lag. In hyperthy- an excess of thyroid hormone occurs in a number of clin-
roid stare (Dalrymple sign) the eyelids are retracted up- ical conditions.
ward more than normal (the normal position is at the
The major causes in humans are:
superior corneoscleral limbus, where the white of the
eye begins at the upper border of the iris). Extra-ocular
muscle weakness may present with double vision. In lid- Graves disease. An autoimmune disease (usually,
lag (von Graefes sign), when the patient tracks an ob- the most common etiology with 50-80% worldwide,
ject downward with their eyes, the eyelid fails to follow although this varies substantially with location- i.e.,
the downward moving iris, and the same type of upper 47% in Switzerland (Horst et al., 1987) to 90% in
globe exposure which is seen with lid retraction occurs, the USA (Hamburger et al. 1981)). Thought to be
due to varying levels of iodine in the diet.[13]
 3

Toxic thyroid adenoma (the most common etiology Hormone) in the blood is typically the initial test for sus-
in Switzerland, 53%, thought to be atypical due to a pected hyperthyroidism. A low TSH level typically in-
low level of dietary iodine in this country)[13] dicates that the pituitary gland is being inhibited or in-
structed by the brain to cut back on stimulating the thy-
Toxic multinodular goiter roid gland, having sensed increased levels of T4 and/or T3
in the blood. In rare circumstances, a low TSH indicates
High blood levels of thyroid hormones (most accurately primary failure of the pituitary, or temporary inhibition
termed hyperthyroxinemia) can occur for a number of of the pituitary due to another illness (euthyroid sick syn-
other reasons: drome) and so checking the T4 and T3 is still clinically
useful.
Inammation of the thyroid is called thyroiditis. Measuring specic antibodies, such as anti-TSH-receptor
There are several dierent kinds of thyroiditis in- antibodies in Graves disease, or anti-thyroid-peroxidase
cluding Hashimotos thyroiditis (Hypothyroidism in Hashimotos thyroiditis a common cause of
immune-mediated), and subacute thyroiditis (De- hypothyroidism may also contribute to the diagnosis.
Quervains). These may be initially associated with
secretion of excess thyroid hormone, but usually The diagnosis of hyperthyroidism is conrmed by blood
progress to gland dysfunction and, thus, to hormone tests that show a decreased thyroid-stimulating hormone
deciency and hypothyroidism. (TSH) level and elevated T4 and T3 levels. TSH is a hor-
mone made by the pituitary gland in the brain that tells
Oral consumption of excess thyroid hormone tablets the thyroid gland how much hormone to make. When
is possible (surreptitious use of thyroid hormone), there is too much thyroid hormone, the TSH will be low.
as is the rare event of consumption of ground beef A radioactive iodine uptake test and thyroid scan together
contaminated with thyroid tissue, and thus thyroid characterizes or enables radiologists and doctors to deter-
hormone (termed hamburger hyperthyroidism). mine the cause of hyperthyroidism. The uptake test uses
radioactive iodine injected or taken orally on an empty
Amiodarone, an anti-arrhythmic drug, is struc- stomach to measure the amount of iodine absorbed by
turally similar to thyroxine and may cause either the thyroid gland. Persons with hyperthyroidism absorb
under- or overactivity of the thyroid. much more iodine than healthy persons which includes
Postpartum thyroiditis (PPT) occurs in about 7% of the radioactive iodine which is easy to measure. A thy-
women during the year after they give birth. PPT roid scan producing images is typically conducted in con-
typically has several phases, the rst of which is hy- nection with the uptake test to allow visual examination
perthyroidism. This form of hyperthyroidism usu- of the over-functioning gland.
ally corrects itself within weeks or months without Thyroid scintigraphy is a useful test to characterize (dis-
the need for treatment. tinguish between causes of) hyperthyroidism, and this en-
tity from thyroiditis. This test procedure typically in-
A struma ovarii is a rare form of monodermal
volves two tests performed in connection with each other:
teratoma that contains mostly thyroid tissue, which
an iodine uptake test and a scan (imaging) with a gamma
leads to hyperthyroidism.
camera. The uptake test involves administering a dose of
Excess iodine consumption notably from algae such radioactive iodine (radioiodine), traditionally iodine-131
as Kelp. (131 I), and more recently iodine-123 (123 I). Iodine-123
may be the preferred radionuclide in some clinics due to
Thyrotoxicosis can also occur after taking too much its more favourable radiation dosimetry (i.e. less radia-
thyroid hormone in the form of supplements, such as tion dose to the patient per unit administered radioactiv-
levothyroxine (a phenomenon known as exogenous thy- ity) and a gamma photon energy more amenable to imag-
rotoxicosis, alimentary thyrotoxicosis, or occult factitial ing with the gamma camera. For the imaging scan, I-123
thyrotoxicosis).[14] is considered an almost ideal isotope of iodine for imag-
ing thyroid tissue and thyroid cancer metastasis.[16]
Hypersecretion of thyroid stimulating hormone (TSH),
which in turn is almost always caused by a pituitary ade- Typical administration involves a pill or liquid containing
noma, accounts for much less than 1 percent of hyperthy- sodium iodide (NaI) taken orally, which contains a small
roidism cases.[15] amount of iodine-131, amounting to perhaps less than a
grain of salt. A 2-hour fast of no food prior to and for 1
hour after ingesting the pill is required. This low dose of
radioiodine is typically tolerated by individuals otherwise
3 Diagnosis allergic to iodine (such as those unable to tolerate contrast
mediums containing larger doses of iodine such as used in
Measuring the level of thyroid-stimulating hormone CT scan, intravenous pyelogram (IVP), and similar imag-
(TSH), produced by the pituitary gland (which in turn ing diagnostic procedures). Excess radioiodine that does
is also regulated by the hypothalamuss TSH Releasing
4 4 TREATMENT

not get absorbed into the thyroid gland is eliminated by 3.2 Screening
the body in urine. Some patients may experience a slight
allergic reaction to the diagnostic radioiodine, and may In those without symptoms who are not pregnant there is
be given an antihistamine. little evidence for or against screening.[21]
The patient returns 24 hours later to have the level of ra-
dioiodine uptake (absorbed by the thyroid gland) mea-
sured by a device with a metal bar placed against the neck, 4 Treatment
which measures the radioactivity emitting from the thy-
roid. This test takes about 4 minutes while the uptake %
is accumulated (calculated) by the machine software. A 4.1 Antithyroid drugs
scan is also performed, wherein images (typically a cen-
ter, left and right angle) are taken of the contrasted thy- Thyrostatics (antithyroid drugs) are drugs that inhibit the
roid gland with a gamma camera; a radiologist will read production of thyroid hormones, such as carbimazole
and prepare a report indicating the uptake % and com- (used in UK) and methimazole (used in US), and
ments after examining the images. Hyperthyroid patients propylthiouracil. Thyrostatics are believed to work by
will typically take up higher than normal levels of ra- inhibiting the iodination of thyroglobulin by thyroper-
dioiodine. Normal ranges for RAI uptake are from 10- oxidase, and, thus, the formation of tetra-iodothyronine
30%. (T4 ). Propylthiouracil also works outside the thyroid
gland, preventing conversion of (mostly inactive) T4 to
In addition to testing the TSH levels, many doctors test for the active form T3 . Because thyroid tissue usually con-
T3, Free T3, T4, and/or Free T4 for more detailed results. tains a substantial reserve of thyroid hormone, thyrostat-
Typical adult limits for these hormones are: TSH (units): ics can take weeks to become eective, and the dose of-
0.45 - 4.50 uIU/mL; T4 Free/Direct (nanograms): 0.82 - ten needs to be carefully titrated over a period of months,
1.77 ng/dl; and T3 (nanograms): 71 - 180 ng/dl. Persons with regular doctor visits and blood tests to monitor re-
with hyperthyroidism can easily exhibit levels many times sults.
these upper limits for T4 and/or T3. See a complete table
of normal range limits for thyroid function at the thyroid A very high dose is often needed early in treatment, but, if
gland article. too high a dose is used persistently, patients can develop
symptoms of hypothyroidism. This titrating of the dose is
In hyperthyroidism CK-MB (Creatine kinase) is usually dicult to do accurately, and so sometimes a block and
elevated.[17] replace attitude is taken. In block and replace treatments
thyrostatics are taken in sucient quantities to completely
block thyroid hormones, and the patient treated as though
they have complete hypothyroidism.[22]

3.1 Subclinical
See also: Symptoms and signs of Graves disease
Subclinical hyperthyroidism
In overt primary hyperthyroidism, TSH levels are low and
T4 and T3 levels are high. Subclinical hyperthyroidism is
a milder form of hyperthyroidism characterized by low or
undetectable serum TSH level, but with a normal serum
free thyroxine level.[18] Although the evidence for doing
so is not denitive, treatment of elderly persons having
subclinical hyperthyroidism could reduce the incidence
of atrial brillation.[19] There is also an increased risk of
bone fractures (by 42%) in people with subclinical hyper-
thyroidism; there is insucient evidence to say whether
treatment with antithyroid medications would reduce that
risk.[20]
4.2 Beta-blockers
Many of the common symptoms of hyperthyroidism such
as palpitations, trembling, and anxiety are mediated by
increases in beta adrenergic receptors on cell surfaces.
Beta blockers, typically used to treat high blood pressure,
are a class of drugs that oset this eect, reducing rapid
pulse associated with the sensation of palpitations, and
decreasing tremor and anxiety. Thus, a patient suering
from hyperthyroidism can often obtain immediate tem-
porary relief until the hyperthyroidism can be character-
ized with the Radioiodine test noted above and more per-
manent treatment take place. Note that these drugs do not
treat hyperthyroidism or any of its long-term eects if left
untreated, but, rather, they treat or reduce only symptoms
of the condition. Some minimal eect on thyroid hor-
mone production however also comes with Propranolol -
which has two roles in the treatment of hyperthyroidism,
determined by the dierent isomers of propranolol. L-
propranolol causes beta-blockade, thus treating the symp-
toms associated with hyperthyroidism such as tremor,
palpitations, anxiety, and heat intolerance. D-propranolol
inhibits thyroxine deiodinase, thereby blocking the con-
4.5 Radioiodine 5

version of T4 to T3, providing some though minimal up even more readily by over-active thyroid cells, the de-
therapeutic eect. Other beta blockers are used to treat struction is local, and there are no widespread side-eects
only the symptoms associated with hyperthyroidism.[23] with this therapy. Radioiodine ablation has been used
Propranolol in the UK, and metoprolol in the US, are for over 50 years, and the only major reasons for not
most frequently used to augment treatment for hyperthy- using it are pregnancy and breast-feeding (breast tissue
roid patients.[24] also picks up and concentrates iodine). Once the thyroid
function is reduced, replacement hormone therapy taken
orally each day may easily provide the required amount
4.3 Diet of thyroid hormone the body needs. There is extensive
experience, over many years, of the use of radio-iodine
People with autoimmune hyperthyroidism should not eat in the treatment of thyroid overactivity and this experi-
foods high in iodine, such as edible seaweed and kelps.[3] ence does not indicate any increased risk of thyroid can-
From a public health perspective, the general introduc- cer following treatment. However, a study from 2007 has
tion of iodised salt in the United States in 1924 resulted reported an increased cancer incidence after radioiodine
in lower disease, goiters, as well as improving the lives of treatment for hyperthyroidism.[28]
children whose mothers would not have eaten enough io- The principal advantage of radioiodine treatment for hy-
dine during pregnancy which would have lowered the IQs perthyroidism is that it tends to have a much higher
of their children.[25] success rate than medications. Depending on the dose
of radioiodine chosen, and the disease under treatment
(Graves vs. toxic goiter, vs. hot nodule etc.), success rate
4.4 Surgery in achieving denitive resolution of the hyperthyroidism
may vary from 75-100%. A major expected side-eect of
Surgery (thyroidectomy to remove the whole thyroid or a
radioiodine in patients with Graves disease is the devel-
part of it) is not extensively used because most common
opment of lifelong hypothyroidism, requiring daily treat-
forms of hyperthyroidism are quite eectively treated by
ment with thyroid hormone. Also, there are some indica-
the radioactive iodine method, and because there is a risk
tions that patients suering from related eye disease ex-
of also removing the parathyroid glands, and of cutting
perience a worsening of this condition, and for this reason
the recurrent laryngeal nerve, making swallowing di-
some patients elect to have a surgical solution. On occa-
cult, and even simply generalized staphylococcal infec-
sion, some patients may require more than one radioac-
tion as with any major surgery. Some people with Graves
tive treatment, depending on the type of disease present,
may opt for surgical intervention. This includes those that
the size of the thyroid, and the initial dose administered.
cannot tolerate medicines for one reason or another, peo-
Many patients are initially unhappy at the thought of hav-
ple that are allergic to iodine, or people that refuse ra-
ing to take a thyroid hormone pill for the rest of their
dioiodine.
lives. Nevertheless, as thyroid hormone is safe, inexpen-
If people have toxic nodules treatments typically include sive, and easy to take, and is identical to the thyroid hor-
either removal or injection of the nodule with alcohol.[26] mone normally made by the thyroid. This therapy is, in
general, extremely safe and very well tolerated by the vast
majority of patients.[29]
4.5 Radioiodine
As radioactive iodine treatment results in destruction of
In iodine-131 (radioiodine) radioisotope therapy, which thyroid tissue, there is often a transient period of several
was rst pioneered by Dr. Saul Hertz,[27] radioactive days to weeks when the symptoms of hyperthyroidism
iodine-131 is given orally (either by pill or liquid) on a may actually worsen following radioactive iodine therapy.
one-time basis, to severely restrict, or altogether destroy In general, this happens as a result of thyroid hormones
the function of a hyperactive thyroid gland. This isotope being released into the blood following the radioactive
of radioactive iodine used for ablative treatment is more iodine-mediated destruction of thyroid cells that contain
potent than diagnostic radioiodine (usually iodine-123 or thyroid hormone. In some patients, treatment with medi-
a very low amount of iodine-131), which has a biolog- cations such as beta blockers (propranolol, atenolol, etc.)
ical half life from 813 hours. Iodine-131, which also may be useful during this period of time. Many patients
emits beta particles that are far more damaging to tissues are able to tolerate the initial few weeks without any prob-
at short range, has a half-life of approximately 8 days. lems.
Patients not responding suciently to the rst dose are Most patients do not experience any diculty after the
sometimes given an additional radioiodine treatment, at a radioactive iodine treatment, usually given as a small pill.
larger dose. Iodine-131 in this treatment is picked up by On occasion, neck tenderness or a sore throat may be-
the active cells in the thyroid and destroys them, render-come apparent after a few days, if moderate inamma-
ing the thyroid gland mostly or completely inactive.[28] tion in the thyroid develops and produces discomfort in
Since iodine is picked up more readily (though not exclu- the neck or throat area. This is usually transient, and not
sively) by thyroid cells, and (more important) is picked associated with a fever, etc.
6 7 OTHER ANIMALS

Women breastfeeding should discontinue breastfeeding 7.1 Cats

for at least a week, and likely longer, following radioactive
iodine treatment, as small amounts of radioactive iodine
Hyperthyroidism is one of the most common endocrine
may be found in breast milk even several weeks after the
conditions aecting older domesticated housecats. Some
radioactive iodine treatment.
veterinarians estimate that it occurs in up to 2% of cats
A common outcome following radioiodine is a swing over the age of 10.[34] The disease has become signif-
from hyperthyroidism to the easily treatable hypothy- icantly more common since the rst reports of feline
roidism, which occurs in 78% of those treated for Graves hyperthyroidism in the 1970s. One cause of hyperthy-
thyrotoxicosis and in 40% of those with toxic multin- roidism in cats is the presence of benign tumors, but the
odular goiter or solitary toxic adenoma.[30] Use of higher reason these cats develop such tumors continues to be
doses of radioiodine reduces the incidence of treatment studied. However, recent research published in Environ-
failure, with penalty for higher response to treatment con- mental Science & Technology, a publication of the Amer-
sisting mostly of higher rates of eventual hypothyroidism ican Chemical Society, suggests that many cases of feline
which requires hormone treatment for life.[31] hyperthyroidism are associated with exposure to envi-
There is increased sensitivity to radioiodine therapy in ronmental contaminants called polybrominated diphenyl
thyroids appearing on ultrasound scans as more uni- ethers (PBDEs), which are present in ame retardants
form (hypoechogenic), due to densely packed large cells, in many household products, in particular, furniture and
with 81% later becoming hypothyroid, compared to some electronics.
just 37% in those with more normal scan appearances The study on which the report was based was conducted
(normoechogenic).[32] jointly by researchers at the EPAs National Health and
Environmental Eects Laboratory and Indiana Univer-
sity. In the study, which involved 23 pet cats with feline
4.6 Thyroid storm hyperthyroidism, PDBE blood levels were three times as
high as those in younger, non-hyperthyroid cats. In ideal
Thyroid storm presents with extreme symptoms of hyper- circumstances, PBDE and related endocrine disruptors
thyroidism. It is treated aggressively with resuscitation that seriously damage health would not be present in the
measures along with a combination of the above blood of any animals, including humans.
modalities including: an intravenous beta blockers Several studies indicate canned sh, liver and giblet pre-
such as propranolol, followed by a thioamide such as pared cat food may increase risk whereas fertilizers, her-
methimazole, an iodinated radiocontrast agent or an io- bicides, or plant pesticides had no eect.[35] Another
dine solution if the radiocontrast agent is not available, study suggests cat litter could be a problem.[36]
and an intravenous steroid such as hydrocortisone.[33]
Mutations of the thyroid-stimulating hormone receptor
that cause a constitutive activation of the thyroid gland
cells have been discovered recently. Many other factors
5 Epidemiology may play a role in the pathogenesis of the disease such
as goitrogens (isoavones such as genistein, daidzein, and
In the United States hyperthyroidism aects about 1.2% quercetin) as well as the iodine and selenium content of
of the population.[1] About half of these cases have obvi- the cats diet.
ous symptoms while the other half do not.[4] It occurs be- The most common presenting symptoms are: rapid
tween two and ten times more often in women.[3] The dis- weight loss, tachycardia (rapid heart rate), vomiting,
ease is more common in those over the age of 60 years.[3] diarrhea, increased consumption of uids (polydipsia)
and food, and increased urine production (polyuria).
Other symptoms include hyperactivity, possible aggres-
sion, heart murmurs, a gallop rhythm, an unkempt ap-
6 Pregnancy pearance, and large, thick claws. About 70% of aicted
cats also have enlarged thyroid glands (goiter).
Recognizing and evaluating hyperthyroidism in preg-
The same three treatments used with humans are also op-
nancy is a diagnostic challenge. Thyroid hormones are
tions in treating feline hyperthyroidism (surgery, radioio-
naturally elevated during pregnancy and hyperthyroidism
dine treatment, and anti-thyroid drugs). The drug that
must also be distinguished from gestational transient thy-
is used to help reduce the hyperthyroidism is methima-
rotoxicosis. See thyroid disease in pregnancy for more
zole. Where drug therapy is used it must be given to
information.
cats for the remainder of their lives but this may be the
least expensive option, especially for very old cats. Anti-
thyroid drugs for cats are available in both pill form and
7 Other animals in a topical gel, that is applied using a nger cot to the
hairless skin inside a cats ear. Many cat owners nd this

gel a good option for cats that don't like being given pills.
Radioiodine treatment and surgery often cure hyperthy-
roidism but some veterinarians prefer radioiodine treat-
ment over surgery because it doesn't carry the risks asso-
ciated with anesthesia. Radioiodine treatment, however,
is not available in all areas for cats as this treatment re-
quires nuclear radiological expertise and facilities as the
cats urine, sweat, saliva, and stool are radioactive for sev-
eral days after the treatment requiring special inpatient
handling and facilities usually for a total of 3 weeks (rst
week in total isolation and the next two weeks in close
connement).[37] In the United States, the guidelines for
radiation levels vary from state to state; some states such
as Massachusetts allow hospitalization for as little as two
days before the animal is sent home with care instruc-
tions. Surgery tends to be done only when just one of
the thyroid glands is aected (unilateral disease); how-
ever, following surgery, the remaining gland may become
over-active. As in people, one of the most common com-
plications of the surgery is hypothyroidism.
7.2 Dogs
Hyperthyroidism is very rare in dogs, occurring in less
than 1% or 2% of them. Instead, dogs tend to have the
opposite problem: hypothyroidism, which can manifest
itself in an unhealthy-appearing coat and fertility prob-
lems in females.[38][39] When hyperthyroidism does ap-
pear in dogs, it tends to be the result of medication to in-
crease the amount of thyroid hormone during treatment
for hypothyroidism. Symptoms usually disappear when
the dose is adjusted.[39][40]
Occasionally dogs will have carcinoma of the thyroid. In
about 90% of these cases the carcinoma is a very ag-
gressive tumor that is invasive and easily metastasizes or
spreads to other tissues, especially the lungs, making the
[10] Chan WB, Yeung VT, Chow CC, So WY, Cockram CS.
prognosis very poor. While surgery is possible, it is often
very dicult due to the fast spread of the tumor to the
surrounding tissue including the arteries, the esophagus,
and the windpipe. It may be possible to reduce the size
of the tumor, thus relieving symptoms and allowing time [11] Faculty of Medicine & Dentistry (2006). Course-Based
for other treatments to work.
If a dog does have a benign tumor, which is the case in
about 10% of the cases, treatment and prognosis are no
dierent from those of the cat. The only real dierence
[12] http://www.endocrineweb.com/hyper2.html
is that most dogs have no symptoms of the tumor.
8 See also
High-output cardiac failure
Jod-Basedow phenomenon
7
9 References
[1] Bahn Chair, RS; Burch, HB; Cooper, DS; Garber, JR;
Greenlee, MC; Klein, I; Laurberg, P; McDougall, IR;
Montori, VM; Rivkees, SA; Ross, DS; Sosa, JA; Stan,
MN (June 2011). Hyperthyroidism and other causes of
thyrotoxicosis: management guidelines of the American
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 9

10 Further reading
Brent, Gregory A. (Ed.), Thyroid Function Testing,
New York : Springer, Series: Endocrine Updates,
Vol. 28, 1st Edition., 2010. ISBN 978-1-4419-
1484-2
Siraj, Elias S. (June 2008). Update on the Diag-
nosis and Treatment of Hyperthyroidism (PDF).
Journal of Clinical Outcomes Management 15 (6):
298307. Retrieved 24 June 2009.

11 External links
Patient information: Hyperthyroidism Article at
UpToDate

Merck Manual article about hyperthyroidism

Gina Spadafori (20 January 1997).
Hyperthyroidism: A Common Ailment in
Older Cats. The Pet Connection. Veterinary
Information Network. Retrieved 28 January 2007.
What is Hyperthyroidism, Causes, Symptoms, Di-
agnosis, Treatment, Prevention
10 12 TEXT AND IMAGE SOURCES, CONTRIBUTORS, AND LICENSES

12 Text and image sources, contributors, and licenses

12.1 Text
Hyperthyroidism Source: https://en.wikipedia.org/wiki/Hyperthyroidism?oldid=678143005 Contributors: Kpjas, Defrenrokorit, Fred
Bauder, Kaijan, DopeshJustin, Wapcaplet, Dgrant, Kimiko, Crusadeonilliteracy, Rursus, Blainster, Diberri, Cutler, Ksheka, Nunh-huh,
Bork, Jfdwol, Hugh2414, Jwdietrich2, Discospinster, Rich Farmbrough, Guanabot, Lachatdelarue, Mozai, Reinyday, Davidruben, Ar-
cadian, Tra, Alansohn, Oliverlewis, Raymond, Wouterstomp, AjAldous, Mhv~enwiki, Mac Davis, Bart133, Antifamilymang, Abanima,
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Wavelength, Mukkakukaku, Wolfmankurd, Chris Capoccia, Raquel Baranow, Ksyrie, Aaronwinborn, Draeco, Yashka78, Grafen, Badag-
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Charliepark, Tempodivalse, AnomieBOT, 1exec1, Truthbeknown2008, Spychotic, Citation bot, Jmarchn, Drchintan2610, ArthurBot, Lil-
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Luigi Albert Maria, Ttt7, Fiskendo, Edith305, Newspringmd7789, Lfrazer12, Unicornhole, FMartins and Anonymous: 301

12.2 Images
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