The thyroid gland is a butterfly-shaped organ located at the base of the neck, in front of the windpipe. It is the “master controller” of metabolism, and plays a key role in our health and wellbeing.1,2 It makes, stores and releases thyroid hormones into the blood, thus regulating metabolism.2 These hormones are essential for the proper functioning of all bodily tissues and organs.3 They enable our body to use its stores of energy efficiently, thereby controlling temperature and allowing our muscles to work properly.3
WHO IS AT RISK?
Thyroid dysfunction is very common throughout the world, especially in women.4 Why women are more at risk than men is not fully understood, but they are not only more likely to have thyroid problems, but also to develop them earlier in life.4
Certain times in a woman’s life make her more vulnerable to thyroid problems. These include:4
Recent pregnancy (hyperthyroidism)
Experiencing hormonal changes due to pregnancy, childbirth or during the menopause (hypothyroidism)
Regardless of your sex, you are at risk of thyroid dysfunctions if you:4
Have a family history of thyroid problems (hypothyroidism and hyperthyroidism)
Have an autoimmune disease such as type 1 diabetes (hypothyroidism and hyperthyroidism)
Are over the age of 60 years (hypothyroidism and hyperthyroidism)
Have a personal history of thyroid disorders or have had thyroid surgery (hypothyroidism and hyperthyroidism)
Have Down’s or Turner’s syndrome (hypothyroidism)
Have a personal history of lithium use (hypothyroidism)
Have consumed significant amounts of iodine via food or medication (hyperthyroidism)
People who have had radiation treatments or whose necks have been exposed to X-rays are also more likely to suffer from thyroid problems.4
Thyroid disorders are some of the most frequent diseases in the world, with about 1.6 billion people worldwide at risk.1 Iodine is an integral part of thyroid hormones and is therefore an important factor in the development of hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid).1 Without sufficient iodine, hypothyroidism, cretinism and other iodine deficiency disorders can develop. Conversely, excessive iodine intake can lead to hyperthyroidism.1
Why is iodine important?
Iodine is essential for thyroid hormone production, for fetal and infant development, and it is a crucial nutrient for proper health at all stages of life.2 As our bodies cannot produce iodine, it should be supplied regularly through a healthy diet.2 Iodine deficiency exists in about 54 countries around the world, according to a report by the World Health Organization (WHO).3
Iodine is the key component in the production of the thyroid hormones thyroxine (T4) and triiodothyronine (T3).4 Thyroid hormones help the body to optimally use energy, stay warm, and keep the brain, heart, muscles and other organs working as they should.5 Thyroid hormones and therefore iodine are essential for fetal growth, bone maturation and brain development.2 According to the WHO, insufficient iodine intake is the most common preventable cause of mental retardation.3
A global campaign to iodize the salt supply in almost all countries has led to an estimated 68% of households now using iodized salt.6 Prior to this campaign, an estimated 2 billion people showed iodine definiency by way of having a goiter in 2005 whereas the actual number was 700 million, sparing 1.3 billion people from this disorder.6 Despite this, approximately 40% of the global population remains at risk for iodine deficiency.7
How much iodine do you need?
A teaspoon of iodine is all you need in your lifetime; however, as the body cannot store iodine for long periods, tiny amounts are needed regularly.2 Most people can tolerate large amounts of iodine without adverse effects. An intake of more than 1,000 micrograms per day may be harmful.2
The daily iodine requirement changes over a person’s life:4
Infants: 110–130 micrograms
Children (1–8 years): 90 micrograms
Children (9–13 years): 120 micrograms
Adolescents and adults: 150 micrograms
Pregnant women: 220 micrograms
Breastfeeding women: 290 micrograms
Note: Infants are at high risk for iodine deficiency because their need for iodine and thyroid hormones in relation to their weight is much higher than at any other time of life.8 It is not recommended to give babies extra salt and thus babies depend greatly on their mother for their source of iodine. Therefore, the American Thyroid Association (ATA) recommends that all breastfeeding women take a supplement containing at least 150 micrograms of iodine per day, alongside other sources of iodine, to ensure both mother and child reach their respective daily idione requirement, as mentioned above.9
When you are planning for a baby, iodine comes first
When you are planning for a baby or are pregnant or breastfeeding, you need to top up your dietary iodine intake. 2,4 Even a mild iodine shortage during pregnancy can have effects on the development and delivery of the baby. Serious iodine deficiency during pregnancy can lead to spontaneous abortion or stillbirth.3 It can also lead to congenital abnormalities such as cretinism, which is a serious, irreversible form of mental retardation.3 The more pervasive, but less visible, effect of iodine deficiency is a reduction in intelligence that may affect home life, schooling and work.3
Talk to your doctor about whether supplements would benefit you, and what iodine supplements you might need.
How to meet your need for iodine
Seafood is a good source because the oceans are rich in iodine.2 Although less high in iodine than most seafood, eggs, meat and dairy products are richer than most foods of plant origin.2 Any salt used at home should be iodized.2 To ensure sufficient intake for babies in the weaning period, the iodine content of homemade or commercial complementary formula/foods should be considered.8
Common sources of dietary iodine:7
Some breads
Iodized table salt
Cheese
Saltwater fish
Cow’s milk
Seaweed (including kelp, dulse and nori)
Eggs
Shellfish
Frozen yogurt
Soy milk
Ice cream
Soy sauce
Iodine-containing multivitamins
Yogurt
The best method to prevent iodine deficiency is long-term dietary supplementation with iodized salt, the strategy recommended by the WHO. The WHO recommends a salt intake of less than 5 grams per day (equivalent to about 1 teaspoon of salt per day) to prevent cardiovascular disease.10 One teaspoon of iodized salt contains about 400 micrograms of iodine.7 To meet the total demand of iodine you should not eat more salt, but consume other iodine-rich foods.2
Iodine deficiency and its health consequences
Chronic iodine deficiency can be detrimental to your health.7 A shortage of iodine leads to decreased thyroid hormone and is the most common cause of an underactive thyroid (hypothyroidism).1,7 The visible and unmistakable effect of iodine deficiency is the enlargement of the thyroid, known as goiter.7 To prevent serious health consequences it is important to recognize the early signs of iodine deficiency.
Here, you can read more and find out how goiter and nodules form — and also how to recognize and treat them.
The following symptoms may indicate a lack of iodine:5,7
Swallowing and breathing problems
Greater neck circumference
Fatigue
Sensitivity to cold
Constipation
Dry skin
Depression
In children:
Mental and physical retardation2
Decline in Intelligence (iodine deficiency depresses IQ by 15 points)11
Reduced school performance12
The most serious consequences of iodine deficiency occur in women who are pregnant or breastfeeding and in children. Sufficient iodine, and hence enough thyroid hormone, is essential for the normal development of the brain and nervous system. The most serious disorder caused by severe iodine deficiency during pregnancy is cretinism, a condition of stunted physical and mental growth.7 But even mild iodine deficiency during pregnancy can be associated with low intelligence in children.7
Sufficient iodine is the best way to prevent these complications, as well as others such as stillbirth, miscarriage or poor growth.7
The International Council for the Control of Iodine Deficiency Disorders (ICCIDD) is a non-profit, non-government organization for the sustainable elimination of iodine deficiency and the promotion of optimal iodine nutrition worldwide.
United Nations Children’s Fund (UNICEF) publishes “Progress for Children”, a statistical review that documents progress towards the “Millennium Development Goals”.
Institute of Medicine of the National Academies. Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington, DC: National Academy Press, 2001.
World Health Organization. Is it true that lack of iodine really causes brain damage? Available at http://www.who.int/features/qa/17/en/. Last accessed February 2022
Qian M, Wang D, Watkins WE et al. The effects of iodine on intelligence in children: a meta-analysis of studies conducted in China. Asia Pac J Clin Nutr 2005; 14: 32–42
Hyperthyroidism, or an overactive thyroid, is when the gland produces and releases too much thyroid hormone into the bloodstream, speeding up the body’s metabolism.1 Hyperthyroidism tends to run in families, occurring most commonly in young women.1 Worryingly, little is known about why specific individuals get this condition.1
If you suffer from hyperthyroidism then you are likely to notice you have lost weight, even if you are eating normally or even more than before.1 You may also feel a fast heart rate.1
Key symptoms of hyperthyroidism
Watch out for the following symptoms:1,2
Fast heart rate (often more than 100 beats per minute)
Nervousness and/or irritability
Weight loss without dietary changes
Prominent, staring eyes (typical for Graves’ disease)
Muscle weakness, especially of the upper arms and thighs
Increased sweating
Frequent bowel movements
Lighter or less frequent menstrual periods
Trembling hands
Fine brittle hair
Smooth and thin skin
It is important that symptoms of hyperthyroidism are not left untreated as serious complications can occur. In addition, hyperthyroidism increases the risk for osteoporosis (loss of bone mass) and bone fractures, with women who have gone through menopause having an even greater risk.4
Symptoms alone do not reliably tell whether you have hyperthyroidism; physical examinations and blood tests are needed.
Who is at risk?
Being female 6
The elderly generation6
People who have relatives with autoimmune disorders6
People with autoimmune diseases such as type 1 diabetes 6
People with a history of thyroid problems, like goiters 6
Patients who have undergone thyroid surgery6
Diagnosing thyroid dysfunction
Thyroid dysfunction can be confirmed by your doctor through a simple blood test to check the level of thyroid-stimulating hormone (TSH) and thyroid hormones in your blood.1
If you are concerned that you could be suffering from problems with your thyroid gland, please discuss this with your doctor. To aid your consultation download our Wellbeing Diary to help you keep a check of the symptoms you are experiencing, or try our short thyroid disorders symptom checker.
How hyperthyroidism is treated
According to the type of hyperthyroidism, your age and health status, and how serious the over-activity of your thyroid is, your doctor will choose a treatment option: that is best suited for you.
Anti-thyroid drugs prevent the thyroid gland from producing new thyroid hormones.1 Alternatively the thyroid tissue can be destroyed using radioactive iodine or by surgically removing parts of or the whole thyroid gland.1 The resulting hypothyroidism is then treated with appropriate medication.1,7
How thyroid hormones impact your heart
The heart is a major target of thyroid hormones. Any change in thyroid hormone levels will be responded to by the heart.
Too much thyroid hormone as a consequence of an overactive thyroid (hyperthyroidism) may cause:8
An increased and stronger heart rate, which can lead to palpitations and atrial fibrillation (irregular heart beat)
Higher blood pressure
Without treatment, an under- or overactive thyroid will worsen or accelerate any pre-existing heart disease or cause new conditions.
Mild hyperthyroidism affects the elderly heart
Mild hyperthyroidism is seen in 0.7–12.4% of the population.9 Patients with an overactive thyroid are assigned to two categories: patients with low, but detectable TSH values and patients with undetectable TSH values.10 Patients with undetectable TSH are at greater risk for developing heart problems such as atrial fibrillation, which is an arrhythmia with chaotic heartbeat that causes poor blood circulation. This is most frequently seen in the elderly with later diagnosis and pre-existing heart disease.9
US guidelines recommend that patients older than 60 years with undetectable TSH values should be treated.10 For younger patients without symptoms, close monitoring seems appropriate.10
Biondi B, Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocr Rev 2008; 29: 76–131.
Bahn RS, Burch HB, Cooper DS et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Endocr Pract 2011; 17: 456–520
Hypothyroidism, or an underactive thyroid gland, is a common condition.1 It is caused when the thyroid gland does not produce enough thyroid hormones. This under-production of hormones slows down the body’s metabolism, often leaving patients feeling cold, tired and depressed.2 If you suffer from hypothyroidism then you are also likely to notice you have gained weight, despite following a sensible diet and exercising regularly.1
Key symptoms of hypothyroidism
The symptoms of hypothyroidism are unpleasant and can affect a person’s self-esteem, work, and home and family life.1-4
Symptoms include:
Fatigue/drowsiness
Cold intolerance
Weight gain or increased difficulty losing weight (despite a sensible diet and exercise)
Depression
Constipation
Abnormal menstrual periods or fertility problems
Joint or muscle problems
Thin and brittle hair and fingernails, and/or dry flaky skin
Decreased libido
If left untreated, hypothyroidism can cause more serious complications and even become life-threatening. Severe complications of hypothyroidism include:
Slip into a coma1
Heart failure1
Severe life-threatening depression1
Coma1
An increased risk of Alzheimer’s disease in women 5
Who is at risk?
Women are generally more prone to developing hypothyroidism, especially during pregnancy, after giving birth and around the menopause6
The elderly generation6
People who have relatives with autoimmune disorders6
People with autoimmune diseases e.g., type 1 diabetes or rheumatoid arthritis6
People with manic depression6
Patients who have undergone radiation treatment or thyroid surgery6
White and Asian populations6
Diagnosing thyroid dysfunction
Many people remain undiagnosed with thyroid problems and suffer for a long time as their symptoms are confused with those of other conditions, such as depression or weight gain. 6 Thyroid dysfunction can be confirmed by your doctor through a simple blood test.6
If you are concerned that you could be suffering from problems with your thyroid gland, please discuss this with your doctor. To aid your consultation, download our Wellbeing Diary to help you keep a check of the symptoms you are experiencing, or try our short thyroid disorders symptom checker.
How hypothyroidism is treated
Treatment for thyroid dysfunction is straightforward, well-established, and highly effective.6 As there is no cure for hypothyroidism, the aim of treatment is to replace the missing thyroid hormones in the body.6 Appropriate medication, taken daily, should enable patients to live a symptom-free life.6
If you have been diagnosed with hypothyroidism, it is important to remember that treatment is a lifelong commitment and medication has to be taken every day, even when your symptoms are under control.6 This may seem a bit daunting, but by taking control of your condition and complying with your medication you should be able to remain symptom-free.6 It is advisable to see your doctor more frequently if any changes in your condition occur.
How thyroid hormones impact your heart
The heart is a major target of thyroid hormones.
Too little thyroid hormone as a consequence of an underactive thyroid (hypothyroidism) may cause:7
Increased levels of low-density lipoprotein (“bad”) cholesterol, total cholesterol, and triglycerides
Higher blood pressure
Low heart rate (less than 60 beats per minute)
Increased stiffness of the walls of the blood vessels
Increased strain on the heart
Even mild hypothyroidism worsens heart disease
Mild hypothyroidism affects 4–20% of the population and is more common in women than in men.8 Older people are more likely to suffer from a slightly underactive thyroid gland.6 If you have both heart disease and a slightly underactive thyroid then it is vital that your thyroid is returned to normal function. The presence of both diseases is associated with increased risk for death from heart disease.9
Iervasi G, Molinaro S, Landi P et al. Association between increased mortality and mild thyroid dysfunction in cardiac patients. Arch Intern Med 2007; 167: 1526–1532
A shortage of iodine in the diet is the world’s number one cause of an enlarged thyroid (commonly known as “goiter”).1 In fact, an estimated 0.7 billion people worldwide are affected by an iodine deficiency.2
How to recognize a goiter
A goiter forms when the thyroid gland attempts to compensate for iodine deficiency and the associated low and/or failed production of thyroid hormones. In this process, it gradually grows from its normal size.1
A person with an immensely enlarged thyroid may have problems swallowing and breathing.3
The American Association of Clinical Endocrinologists recommends the so-called “neck check” to help people recognize a possibly enlarged thyroid.4
Simple visual classification can be inaccurate — primarily due to the possibility of human error and variations in individual anatomy (e.g. a muscular neck can conceal an enlarged thyroid) — and should by no means serve as a substitute for a specific diagnosis by a doctor.
How to recognize a nodule
Thyroid nodules are abnormal overgrowths of tissue in the thyroid gland.5 Some people develop one nodule while others develop many.5 Thyroid nodules are relatively common, with as many as half of all people having at least one nodule by the time they reach the age of 60.5 Just as with goiter formation, the formation of thyroid nodules can be caused by insufficient iodine in the diet.6
Thyroid nodules are classified by scans as “hot”, “warm” or “cold”. If a nodule does not produce iodine then it will appear “cold” on the scan. Those that do produce iodine will show up darker and are called “hot”. Approximately 85% of nodules are cold, 10% are warm and 5% are hot. Of these, 85% of cold nodules are benign (non-cancerous), as are 90% and 95% of warm and hot nodules, respectively.7
Initially, most thyroid nodules do not cause any noticeable symptoms.6 They often go undiscovered until the next routine medical examination or on imaging tests such as computed tomography (CT) scans or neck ultrasound, done for unrelated reasons.6 As the thyroid nodules grow further, the following symptoms can occur (although this is rather rare):
Difficulty swallowing or pain upon swallowing6
Difficulty breathing6
Hoarseness6
Symptoms of hyperthyroidism5
Upon the onset of breathing difficulties, , a doctor should be consulted immediately. If you believe that a nodule has formed in your own thyroid gland, you can perform the so-called “neck check”, as set forth by the American Association of Clinical Endocrinologists.4
Diagnosis and treatment
Following a simple physical examination by a doctor, a blood sample is taken to determine whether there is a sufficient amount of TSH in the bloodstream.1 This hormone is an indicator of whether the thyroid gland is functioning normally. Ultrasonography (an ultrasound scan) is performed to determine the actual size of the nodules and thyroid gland.1 This scan is completely painless. Other methods for examining nodules include a radioactive iodine scan and fine-needle biopsy.1
How are goiter and nodules treated?
Not every goiter and nodule requires treatment.3 Depending on their type and size, their development might merely be regularly observed. In general, there are three treatments. The choice of therapy depends on each individual patient’s diagnosis. The primary aim of treatment is to shrink the enlarged thyroid gland and the nodules.
Treatment with medication(s)
For goiters and nodules that occur due to an iodine deficiency, iodine supplementation can be given.1 If the goiter is due to Hashimoto’s thyroiditis and you have hypothyroidism, you will be given the appropriate medication to restore your thyroid hormone levels to normal.1 When goiters and nodules are accompanied by hyperthyroidism (e.g. as in the case with “hot” nodules), additional medications are prescribed.1,7
Radioiodine therapy
Radioiodine is administered on a one-off basis, in the form of a pill. It enters the thyroid gland via the bloodstream, where it is stored — and prompts the shrinkage of the thyroid tissue due to short-range radiation.3
Thyroid surgery
If a thyroid nodule is detected, one treatment involves removing the whole thyroid gland via surgery. In addition, the thyroid gland can be partially or completely removed if a goiter or nodules are causing immense discomfort. Following such a procedure, treatment with substitution therapy is required to replace thyroid hormone production.3
Regardless of the particular therapy — and also to help prevent thyroid disorders — you should always ensure adequate iodine intake in your diet.
In most areas of the world, the incidence of thyroid cancer has increased over the last few decades but related mortality has been declining.1 Incidence rates in high-income countries are double those in low- and middle-income countries.1
Types of thyroid cancer
Thyroid cancers are classified according to the type of cancer, its size and its tendency to spread.2 Thyroid cancer is usually treatable and can be cured by surgery and, if indicated, radioactive iodine.3 There are four primary types of thyroid cancer.3
Papillary thyroid cancer is the most common type, accounting for 70–80% of cases and can occur at any age. It is a slow-growing tumor with a tendency to spread into the lymph nodes in the neck.3
Follicular thyroid cancer, comprising 10–15% of all thyroid cancers, is also slow-growing and can spread into the lymph nodes, bloodstream and more distant tissues, including the bones and the lungs.3
Medullary thyroid cancer makes up about 2% of cases, 25% of those cases run in families, and is associated with other endocrine tumors. Therefore, family members of a patient with medullary thyroid cancer should be tested for the genetic mutation.2,3
Anaplastic thyroid cancer is the most aggressive thyroid cancer and the least likely to respond to treatment. It accounts for fewer than 2% of cases. It is a fast-growing tumor that spreads quickly and is difficult to treat.3
How is thyroid cancer diagnosed?
Thyroid cancer often develops in lumps or nodules without causing symptoms.3 Nodules are often detected incidentally, for example by CT or ultrasound scans performed for other reasons.3 The examination of the thyroid is performed by thyroid ultrasound.3 A microscopic examination of the tissue sample taken by fine-needle aspiration biopsy will show whether there are cancer cells and, in the case of diagnosis, what type of cancer they are.3 Fortunately, less than one in 10 nodules are cancerous.3
The diagnosis of thyroid cancer is a shock, and is usually followed by a flood of emotions such as sadness, fear, anger and helplessness. Learning more about your illness and the medical care available may help you overcome your fear and any feelings of helplessness. It also allows you to take an active part in the treatment process. The good news is that thyroid cancer can be treated and often cured.
Treatment of thyroid cancer
According to the American Thyroid Association, the primary treatment for all forms of thyroid cancer is the removal of part of or the entire thyroid gland by surgery.3 If the tumor has already spread into the lymph nodes in the neck or upper chest then these lymph nodes will also be removed.3 After the removal of the thyroid you will be prescribed appropriate medication. You will have to take medication on a permanent basis.3
If your tumor is large or has spread to other tissues, your doctor will probably recommend radioactive iodine (RAI) therapy after surgery.3 RAI will kill the remaining cancer cells, even those in distant tissues.3 In preparation for this treatment, you will be made hypothyroid either by stopping treatment or injecting TSH.3 The less iodine in your body, the more effective the treatment.3 You should speak to your doctor about how to balance the potential risks against the benefits of this treatment.
In patients with advanced stages of thyroid cancer, surgery and RAI treatment may not work. Your doctor then will propose radiation therapy, chemotherapy or a combination of both.3
After successful treatment, periodic follow-up examinations are necessary to be sure that the cancer has not come back. These check-ups will include physical and ultrasound examinations of the neck area and blood tests. Blood tests will show whether you are receiving the right amount of thyroxine and monitor for the presence of thyroglobulin. After thyroid removal and RAI treatment, your body should no longer produce the protein thyroglobulin (a protein produce only in the thyroid gland). If it shows up in a blood test then it is likely that your thyroid cancer has returned.3
Note: According to the American Thyroid Association, differentiated and papillary thyroid cancer patients younger than 45 years of age with a small-sized tumor or cancer confined to the thyroid gland have an excellent recovery rate.3 For these patients, the 10-year survival rate is 100%.3 For all thyroid cancer patients diagnosed in the USA between 2006 and 2012, a 5-year survival rate of 98.1% has been reported.4
Hashimoto’s thyroiditis is an autoimmune disease in which the body’s immune system turns against itself and attacks the thyroid.1 This leads to the gradual, long-term destruction of the thyroid gland, and therefore insufficient levels of thyroid hormones.1 As the disease progresses, the thyroid may produce too few thyroid hormones, resulting in hypothyroidism.1
Who is at risk?
Hashimoto’s thyroiditis can affect any individual at any age, but mostly occurs in middle-aged women and people with a family history of thyroid disorders.1 Why the immune system attacks the thyroid gland is not yet known, but possible risk factors include viral or bacterial infection and having another autoimmune disease such as type 1 diabetes.2
Symptoms of Hashimoto’s disease
This disease can go unnoticed for a long time. In the course of the disease the thyroid gland can become exhausted, and you might develop hypothyroidism with symptoms such as:1,3
Fatigue and drowsiness and/or weakness
Cold intolerance
Difficulty concentrating or thinking
Depression
Weight gain
Enlarged neck or presence of goiter, which may be an early symptom, and, later in the disease, a small or shrunken thyroid gland
Abnormal menstrual periods with heavy/irregular menses
Constipation
Joint or muscle pain
Hair loss
Dry skin
How Hashimoto’s thyroiditis is diagnosed
People with Hashimoto’s thyroiditis often present symptoms of hypothyroidism, sometimes accompanied by the finding of a goiter.3 Symptoms alone are not a reliable proof of this disease. Blood tests are needed to make a valid diagnosis. If you have high levels of TSH in the blood and low levels of free T4 (thyroxine circulating freely in the blood) you probably have hypothyroidism.4 Antibodies against thyroid peroxidase, an enzyme involved in the production of thyroid hormones, are usually elevated in cases of Hashimoto’s thyroiditis.3
Treatment for the disease
If you are diagnosed with Hashimoto’s thyroiditis your doctor will prescribe thyroxine replacement hormone to treat this condition.1 Most patients with Hashimoto’s thyroiditis will require lifelong treatment with the appropriate medication.3 Finding the appropriate dose, particularly at the beginning may require testing with TSH every 6-8 weeks after any dose adjustment, until the correct dose is determined. After that, monitoring of TSH once a year is generally sufficient.3
Like Hashimoto’s thyroiditis, Graves’ disease is an autoimmune disease that leads to a generalised overactivity of the entire thyroid gland. 1 About 25–40% of Graves’ disease patients show signs of a clinically relevant Graves’ ophthalmopathy (inflammation and bulging of the eyes).3 However, Graves’ disease accompanied by moderate to severe Graves’ ophthalmopathy, only occurs in fewer than 5% of patients.2
Who is at risk?
Women under 40 years of age are especially prone to developing Graves’ disease.3 Smokers are more likely to have Graves’ disease and are more likely to have eye problems than non-smokers.3
Symptoms of Graves’ disease
This disease can go unnoticed for a long time, but you may experience some of the following symptoms:1,4
Fast heart rate
Nervousness and/or irritability
Anxiety
Difficulty sleeping
Weight loss without dietary change
Muscle weakness, especially of the upper arms and thighs
Increased sweating
Frequent bowel movements
Lighter or less frequent menstrual periods
Trembling hands
Thinning of the skin
Fine brittle hair
Symptoms of Graves’ ophthalmopathy include:1
Red or inflamed eyes
Tissue swelling around the eyes
Bulging eyes
Very rarely, diminished or double vision
Diagnosing Graves’ disease
Your doctor cannot tell from the symptoms alone whether you have Graves’ disease. Physical examinations and blood tests are needed for a definite diagnosis.1 Indicators include low levels of TSH and elevated levels of free thyroxine.5 In order to determine the extent of your hyperthyroidism, a triiodothyronine test will also be performed. If hyperthyroidism, enlarged thyroid gland, and eye problems described above coexist, the diagnosis of Graves’ disease appears self-evident.5
Treatment of Graves’ disease
Your doctor will discuss with you the best treatment options to prevent the thyroid gland from producing excess thyroid hormones.
Anti-thyroid drugs allow control of hyperthyroidism by inhibiting the thyroid hormones’ synthesis in thyroid glands. They should be taken for at least 6 months to 2 years .5 In a small number of patients, the disease may permanently resolve.5
Destroying thyroid tissue by radioactive iodine radiation is another option, but it will take 6–18 weeks before the benefit is reached.5
The third option is to remove parts of or the whole thyroid gland by surgery.5
The last two options may provoke hypothyroidism in the long run.5 Your thyroid hormone levels will then be restored to normal by taking appropriate medication.1 If you suffer from the symptoms of Graves’ disease (such as fast heart rate, anxiety, heat intolerance and trembling hands) then your doctor may temporarily prescribe beta-blockers, which will make you feel better within a short time.4,5 Regular check-ups guarantee long-lasting treatment success1.
Ginsberg J. Diagnosis and management of Graves’ disease. CMAJ 2003; 168: 575–585
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Date of preparation: February 2022
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