Underactive thyroid function is incredibly common. The government says 4.6% of the population experience hypothyroidism. We suspect it might be substantially higher. That’s because over 20 million Americans take levothyroxine for HYPOthyroidism. That’s closer to 7% of the population. The opposite condition, HYPERthyroidism, affects 1.2% of the population, according to the feds. That’s roughly 3 million people. How do doctors calm hyperthyroidism? Why can’t you ignore this condition?
When the Thyroid Goes into Overdrive:
We have written extensively about the symptoms of hypothyroidism and its treatment in our eGuide to Thyroid Hormones. Fatigue, depression, weight gain and constipation are just a few of the many complications of a sluggish thyroid gland.
An overactive thyroid can cause different, but equally distressing, symptoms. Shaky hands, heat intolerance, nervousness and mood swings are quite common.
Why Can’t You Just Ignore Hyperthyroidism?
This reader wants to know why hyperthyroidism requires treatment:
Q. I have hyperthyroidism. Is there a reason for treating it, other than my typical symptoms? My hands do shake ridiculously, and I have insomnia. But my attitude is “so what?” Is there any more serious reason for concern?
A. Left untreated, an overactive thyroid gland can lead to some serious complications. Graves’ disease (an autoimmune condition that can cause hyperthyroidism) is associated with eye problems, heart rhythm disturbances and osteoporosis. And that could lead to fractures down the road.
If you think of your thyroid gland as a master controller, you will easily understand why you don’t want to ignore excessive thyroid hormone circulating through your body. It would be as if your car engine was idling at a much higher RPM rate than normal. Another way to imagine it would be as if the thermostat in your house was turned to a higher temperature than would be comfortable. The body just goes into overdrive.
That is why people often lose weight or have a rapid heart rate. Some people feel anxious or “twitchy.” If hyperthyroidism gets out of control it can lead to something referred to as thyroid “storm.” This is often a medical emergency. Symptoms may include elevated blood pressure, very rapid pulse, agitation, shaking, diarrhea, confusion and high fever. Any of these should lead to prompt emergency care!
Iodine Contrast Media and Hyperthyroidism:
This reader developed symptoms of an overactive thyroid gland after getting an injection of iodine for a scan of the abdomen.
Q. Three years ago, I had several scans with iodine for diverticulitis. As a result, I developed hyperthyroidism. I lost weight, couldn’t sleep and developed irregular heartbeats and other signs of hyperthyroidism.
I went to a thyroid doctor, and he found anti-thyroid antibodies. After three years, my situation has calmed down some, but I still can’t sleep well and have other symptoms of excess thyroid. Besides avoiding iodine, what else can I do to treat my overactive thyroid?
A. Iodine is a common component of contrast media used for medical images such as X-rays and CT scans. Some people react to this exposure by developing thyroid problems.
Some common symptoms of hyperthyroidism include insomnia, anxiety, tremor, heart palpitations, rapid pulse and weight loss.
Another Reader Shares an Iodine Challenge:
Q. I’ve had Graves’ disease for years. Today I manage it with methimazole every other day.
The symptoms that I experienced were extreme mental and physical fatigue, as if I’d run a marathon. These symptoms crept up slowly over time. The symptom that was most debilitating was brain fog and feeling very disorganized. I also experienced weight loss.
I had a scan that required iodine two weeks ago and my sleep has been terribly disrupted since. I had asked the technician if it would bother my thyroid and she said no. Now I know better. A lot has been written about hypothyroidism, but there is not much for people like me with hyperthyroidism. I’d appreciate any information you can offer.
A. Graves’ disease is an autoimmune condition resulting in too much thyroid hormone (hyperthyroidism). Symptoms can include fatigue, insomnia, anxiety, rapid pulse, heart palpitations, tremor, hair loss, frequent bowel movements and eye problems. Iodine contrast material can trigger thyroid dysfunction (European Thyroid Journal, July, 2021; Journal of Clinical Endocrinology & Metabolism, Feb. 2015).
You can learn more about both hyper– and hypothyroidism in our eGuide to Thyroid Hormones. This online resource may be found under the Health eGuides tab.
If you ever need another scan, please discuss your condition with the radiologist beforehand. It may be possible to utilize a different contrast medium without iodine.
How Do Doctors Calm Hyperthyroidism?
There are three common ways to treat hyperthyroidism: surgery, radioactive iodine or thyroid-suppressing drugs such as methimazole. Where you live will have a profound impact on the kind of treatment that you get.
In the United States, endocrinologists generally like to burn out the thyroid gland with radioactive iodine.
According to an international analysis published in Nature Reviews Endocrinology (May, 2018).
“Unlike in Europe, endocrinologists in the US have traditionally preferred radioiodine over antithyroid drugs. Two-thirds of American Thyroid Association respondents favoured the use of radioiodine as the primary treatment modality for Graves disease, whereas only 20% of members of European and UK thyroid societies said that they would use radioiodine as primary therapy. In South Korea, 10% of practitioners recommended thyroidectomy [thyroid gland surgical removal] as first-line treatment for Graves disease in contrast to other regions, such as Europe and the USA, where thyroidectomy is hardly used first line.”
Radioactive Iodine to Calm Hyperthyroidism:
As noted above, specialists in the United States have leaned heavily towards radioactive iodine to knock out the hyperactive thyroid gland. This therapy has been used for 70 years and is perceived as quite safe.
Here is the government’s perspective on radioiodine:
“Radioactive iodine is a common and effective treatment for hyperthyroidism. In radioiodine therapy, you take radioactive iodine-131 by mouth as a capsule or liquid. The radioactive iodine slowly destroys the cells of the thyroid gland that produce thyroid hormone. Radioactive iodine does not affect other body tissues.”
The idea that radioactive iodine “does not affect other body tissues” may have to be revised. A study published in JAMA Internal Medicine (July 1, 2019) links this treatment with an increased risk for certain cancers. You can read our analysis about this discovery at this link.
Antithyroid Medicines to Calm Hyperthyroidism:
Methimazole is a very old drug frequently prescribed to control hyperthyroidism. Pregnant women are prescribed a different drug, propylthiouracil.
Veterinarians also prescribe methimazole to cats with hyperthyroidism. By the way, there is currently an epidemic of this disorder in our feline companions. No one seems to know why, though we suspect environmental toxins. We wonder if this hypothesis might also apply to cat companions (aka humans).
Although methimazole can sometimes “cure” hyperthyroidism, that may take up to two years. Even after that time, some people have to take the drug indefinitely to calm hyperthyroidism.
Side effects can include a rash, reduced white blood cells and susceptibility to infections, indigestion and nausea, headache, dizziness, drowsiness, and muscle aches. If you develop a sore throat or other signs of infection, get a blood test immediately, as this could signal a life-threatening blood disorder.
Surgery to Remove the Thyroid Gland:
One way to get rid of an overactive thyroid gland is to remove it partially or completely. This can lead to hypothyroidism. Most patients who have undergone thyroidectomy will be prescribed thyroid hormones for the rest of their lives.
You can learn much more about the thyroid gland and its treatment in our eGuide to Thyroid Hormones at this link.
If you ever need a CT scan or an x-ray with contrast, find out if they will be using iodine. If so, you will want to monitor your thyroid function carefully during the weeks and months following this procedure. You can learn more about iodine and the thyroid at this link.
Final Words and Natural Therapies:
Weighing the pros and cons of each treatment is critical. You will need a doctor you can trust to help you assess which treatment is best for you. There are some data to suggest that the amino acid L-carnitine may be partially helpful (European Review for Medical and Pharmacological Sciences, May, 2017). In addition to 500 mg of L-carnitine, the authors also prescribed low doses of selenium (83 micrograms).
This is not the only study suggesting the usefulness of L-carnitine to calm hyperthyroidism. Italian researchers reported that this dietary supplement could be helpful (Journal of Clinical Endocrinology and Metabolism, Aug. 2001).
Here are their final words:
“In conclusion, L-carnitine is effective in both reversing and preventing symptoms of hyperthyroidism and has a beneficial effect on bone mineralization. Because hyperthyroidism depletes the body deposits of carnitine and since carnitine has no toxicity, teratogenicity, contraindications and interactions with drugs, carnitine can be of clinical use.”
A review of other nutraceutical supplements (Nutrients, Sept. 2019) suggests that resveratrol might also be helpful.
Vitamin B12 can be low in patients with hyperthyroidism. If a deficiency exists, please ask your physician for a dose of B12 to get you back in balance.
Herbs such as lemon balm, motherwort and bugleweed may also be beneficial. Before adding any such supplements, consult your endocrinologist. Balancing medications and natural approaches can be tricky.
Share Your Story:
Have you experienced hypo- or hyperthyroidism? What has it been like? Please let others know what you have been through in the comment section below.
You can learn more about both under- and overactive thyroid in our eGuide to Thyroid Hormones. This online resource is accessible in the Health eGuide section of this website.
