Hyperthyroidism treatments and medications

Hyperthyroidism (also known as overactive thyroid) is a medical condition where the thyroid gland makes too much thyroid hormone. The thyroid is a small gland in the front of your neck—it’s shaped like a butterfly. Thyroid hormones affect almost every organ in the body, and with too much thyroid hormone, many of the body’s functions speed up. Hyperthyroidism can be treated with various medications, radioactive iodine, or surgery. Let’s take a look at what this condition is and what can be done to treat it.

What is hyperthyroidism?

Hyperthyroidism is an overactive thyroid. The thyroid makes hormones that control the way your body uses energy. These hormones affect almost every organ in the body—they affect breathing, heart rate, mood, digestion, and weight. Left untreated, hyperthyroidism can cause serious complications, including problems with the heart, muscles, bones, menstrual cycle, and fertility.

You may have some, or even multiple, symptoms of hyperthyroidism. Symptoms of overactive thyroid may include:

• Palpitations (fast heartbeat)

• Shakiness

• Nervousness

• Increased appetite

• Weight loss

• Diarrhea

• Vision changes

• Skin that is thin, warm, and moist

• Menstrual cycle changes

• Excess sweating

• Sleep problems

• Swelling of the neck due to an enlarged thyroid gland (goiter)

• Hair loss or brittle hair

• Bulging of the eyes (associated with Graves’ disease)

• Weak muscles

Older adults may have less noticeable symptoms. They may have an increased heart rate, fatigue, and withdrawal from usual activities. Sometimes hyperthyroidism may be misdiagnosed as depression or dementia.

About one out of every 100 people in the United States age 12 years and older have hyperthyroidism.

Hyperthyroidism is treated with antithyroid drugs methimazole or propylthiouracil, radioactive iodine, or surgery. Beta-blockers are also sometimes used to control associated symptoms. We will discuss treatment in detail later in the article.

Although there are treatments available for hyperthyroidism, there is ongoing research and development on the condition. A search on clinicaltrials.gov brings up over 250 studies related to hyperthyroidism.

What are the possible causes of hyperthyroidism?

Possible causes of hyperthyroidism can include:

• Graves’ disease: This autoimmune disorder is the most common cause of hyperthyroidism (and is most common in young women)—it causes 70% of hyperthyroidism cases. The immune system attacks the thyroid, causing it to make too much thyroid hormone.

• Thyroid nodules: More common in older adults, these growths on the thyroid are usually noncancerous but may become overactive and make too much thyroid hormone.

• Thyroiditis: Inflammation of the thyroid causes thyroid hormone to leak from the thyroid gland.

• Too much iodine: Taking too much iodine, which is found in seaweed, seaweed-based supplements, and some medicines or cough syrups, can cause an overactive thyroid.

• Too much thyroid medicine: People with hypothyroidism (underactive thyroid) who take too much thyroid hormone medicine can develop an overactive thyroid.

Who is at higher risk for hyperthyroidism?

People at higher risk for overactive thyroid include:

• People who were assigned female at birth

• People with a family history of thyroid disease

• Individuals younger than 40 years old or older than 60 years old

• Individuals with medical conditions such as Type 1 diabetes, pernicious anemia, or an immune system condition

• People who consume large amounts of iodine

• Pregnant women or women who recently gave birth

How is hyperthyroidism diagnosed?

If you have symptoms of overactive thyroid, consult a healthcare provider. You can see a primary care provider or endocrinologist, a doctor who specializes in hormone-related conditions. Some people, such as individuals with less noticeable symptoms, may be diagnosed on a routine visit.

Physical exam

Your healthcare provider will check:

• Your thyroid to see if it is enlarged or tender

• Your eyes for signs of Graves eye disease like swelling, bulging, and redness

• Your heart for a rapid or irregular heartbeat

• Your hands for tremor (shaking)

• Your skin to see if it is warm and moist

Blood tests

Your provider may order blood tests, including:

• Thyroid hormones: If you have an overactive thyroid, levels of thyroid hormones T3 and T4 will be elevated, and thyroid-stimulating hormone, or TSH, will be lower.

• Thyroid receptor antibody (TRAb)

• Thyroid stimulating immunoglobulin (TSI)

They may also order other tests, such as cholesterol and blood sugar.

Imaging

Imaging tests may include:

• Radioactive iodine uptake (RAIU) test: In this test, the patient takes a small dose of radioactive iodine to see how much the thyroid absorbs. The healthcare provider will scan the neck, usually 6 and 24 hours later, to see how much radioactive iodine has been absorbed. A large amount of radioactive iodine absorbed means the thyroid is making too much thyroxine (T4).

• Thyroid scan: This scan is an extension of the RAIU. The patient lies on a table, and a camera takes images of the thyroid.

• Thyroid ultrasound: This is a non-invasive procedure that allows your healthcare provider to see your thyroid and look for nodules.

Hyperthyroidism treatment options

If you are diagnosed with hyperthyroidism, you’ll want to know your treatment options. They may include:

Prescription medications

Prescription medications may include antithyroid medications, which cause the thyroid to make less thyroid hormone. You may need to take this type of medicine for a year or two, or even longer. Beta-blocker medications are sometimes prescribed as well. While they do not affect the thyroid directly, beta-blockers can help with other symptoms such as fast heartbeat, nervousness, and shaking.

Radioactive iodine

This common treatment is considered very effective. The patient takes radioactive iodine by mouth as a pill or liquid. The radioactive iodine slowly destroys thyroid gland cells without affecting other parts of the body. In almost every case, radioactive iodine treatment will lead to hypothyroidism (underactive thyroid) because it destroys thyroid gland cells. However, hypothyroidism is considered easier to treat and causes fewer long-term complications than an overactive thyroid.

Surgery

Surgery to remove part of the thyroid gland is generally only done in rare cases, such as patients with large goiters or pregnant individuals who cannot take antithyroid medication. If part of the thyroid is removed, you may need to take thyroid replacement medication. If the entire thyroid is removed, you will need to take thyroid replacement medication for the rest of your life.

Hyperthyroidism medications

Antithyroid agents

Antithyroid medications include methimazole and propylthiouracil. They work by preventing the thyroid from making too much thyroid hormone. Methimazole and propylthiouracil are both available as a tablet that is taken by mouth. Because there are additional warnings regarding pregnancy and breastfeeding, anyone who is pregnant, planning to become pregnant, or breastfeeding, should consult their healthcare provider for more information.

Common side effects of methimazole include rash/hives, muscle and joint pain, numbness, and tingling, loss of taste, hair loss, headache, drowsiness, and swelling. Stomach problems, such as nausea, vomiting, and indigestion, may occur. Serious side effects may include liver problems and life-threatening infections. People who take methimazole should avoid people who are sick or have an infection and should tell their healthcare provider right away if they develop signs of infection. Signs of an infection may include weakness, fever, chills, sore throat, mouth sores, painful swallowing, red/swollen gums, pale skin, easy bruising, or unusual bleeding.

Propylthiouracil should only be used in people who cannot take methimazole or undergo treatment with radioactive iodine therapy or have surgery. This is because propylthiouracil can cause severe liver injury and liver failure, which may require a liver transplant or can cause death.

Common side effects of propylthiouracil include rash/hives, joint pain, fever, altered taste, nausea, and vomiting. Serious side effects may include liver problems, which can cause death. Stop taking this medication and call your healthcare professional right away if you have upper stomach pain, nausea/vomiting, appetite loss, fever, itching, tiredness, dark urine, clay-colored stools, or yellowing of the skin or whites of the eyes. Propylthiouracil can also cause a life-threatening skin reaction. Get emergency medical help if you have a fever, sore throat, burning eyes, skin pain, red/purple rash, or blistering or peeling skin.

Beta-blockers

Beta-blockers do not affect the thyroid gland directly, but they can help with symptoms of an overactive thyroid, such as fast heartbeat, nervousness, and tremors. Commonly prescribed beta-blockers for hyperthyroidism include Tenormin (atenolol) or Inderal (propranolol).

Beta-blockers block some of the effects of excess thyroid hormone but do not prevent the thyroid from making less hormone. Beta-blockers should never be stopped abruptly because doing so can worsen certain heart conditions.

Common side effects of atenolol include slow heartbeat, low blood pressure, tiredness/drowsiness, dizziness/lightheadedness, vertigo, cold extremities, depression, shortness of breath, leg pain, nausea, and diarrhea. Serious side effects of atenolol may include heart and heart rhythm problems, Raynaud’s syndrome (decreased blood flow to the extremities), and lupus.

Common side effects of propranolol include tiredness, dizziness, constipation, slow heartbeat, low blood pressure, depression, trouble sleeping, weakness, disorientation, hair loss, impotence, nausea, and diarrhea. Serious side effects of propranolol may include heart and heart rhythm problems, Raynaud’s syndrome, lupus, and severe skin reactions. Skin reactions can be life-threatening and require emergency medical help (if you have symptoms of fever, sore throat, burning eyes, skin pain, red/purple rash, or blistering or peeling skin).

What is the best medication for hyperthyroidism?

The best medication for hyperthyroidism depends on your symptoms, diagnosis, other medical conditions, medical history, and other individual factors. The table below compares the most commonly prescribed hyperthyroidism medications. You can always use a SingleCare discount card to save on the cost of your prescription medications.

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What is the best medication for hyperthyroidism?