Hyperthyroidism

Hyperthyroidism

Definition
Hyperthyroidism is a state in which the thyroid gland secretes excess thyroid hormones (T3 and T4). The surplus speeds up the body’s metabolism and produces a characteristic set of symptoms.

Causes / Etiology

• Graves’ disease – autoimmune stimulation of the gland by thyroid‑stimulating antibodies.
• Toxic multinodular goitre – several autonomous nodules produce hormone.
• Toxic adenoma – a single “hot” nodule secretes hormone.
• Thyroiditis (sub‑acute, painless) – inflammation releases stored hormone.
• Iodine excess or ingestion of thyroid hormone tablets (iatrogenic).

Types or Classification (one line each)
Graves’ disease – autoimmune hyperthyroidism with eye signs.
Toxic multinodular goitre – multiple over‑active nodules in an enlarged gland.
Toxic adenoma – solitary over‑active nodule, often found incidentally.
Thyroiditis – transient hyperthyroidism due to leakage of pre‑formed hormone.
Iatrogenic – caused by over‑replacement of thyroid hormone.

Pathology (stepwise)
Step 1 → Thyroid follicular cells are overstimulated (by antibodies, autonomous nodules or excess iodine).
Step 2 → Synthesis and release of large amounts of T3/T4 into the circulation.
Step 3 → Hormones bind to nuclear receptors in almost every tissue → ↑ basal metabolic rate, ↑ oxygen consumption, ↑ sympathetic activity.
Step 4 → Clinical picture of weight loss, heat intolerance, tachycardia, tremor, etc.

Clinical Features

General (systemic) –

• Unexplained weight loss despite good appetite.
• Heat intolerance, profuse sweating.
• Palpitations, rapid pulse.
• Tremor of hands (fine shaking).
• Nervousness, irritability, insomnia.

Specific –

• Diffuse goitre (smooth, soft enlargement of thyroid).
• Exophthalmos (bulging eyes) and lid lag in Graves’.
• Fine hair loss, skin warm and moist.

Complications

Acute –

• Thyroid storm: sudden severe exacerbation with fever, delirium, heart failure; a medical emergency.
• Atrial fibrillation leading to rapid ventricular response.

Chronic –

• Osteoporosis due to increased bone turnover.
• High‑output cardiac failure (dilated cardiomyopathy).
• Muscle wasting (proximal weakness).

Diagnosis / Investigations

Routine –

• Serum TSH: low or suppressed.
• Free T3 and Free T4: elevated.

Special –

• Radioactive iodine uptake (RAIU) scan: high uptake in Graves’ or toxic nodules; low uptake in thyroiditis.
• Thyroid‑stimulating immunoglobulin (TSI) or TSH‑receptor antibody test: positive in Graves’.
• Thyroid ultrasound: helps to identify nodules and guide RAIU.

Management

General –

• Beta‑blockers (propranolol) for tachycardia, tremor and anxiety.
• Adequate rest, avoid excess iodine foods.

Modern treatment –

• Antithyroid drugs (methimazole or carbimazole) to block hormone synthesis.
• Radioactive iodine (I‑131) ablation for definitive therapy in most adults.
• Total or near‑total thyroidectomy when large goitre, suspicion of cancer or contraindication to RAI.

Dietary advice –

• Iodine‑restricted diet only if excess iodine is the cause; otherwise normal iodine intake.
• Calcium‑vitamin D supplementation to protect bone health.
• Small, frequent meals to meet increased metabolic demand.

Homeopathic Therapeutics (key remedies, 6‑7 points each)

Thyroidinum –

• Palpitations with rapid, irregular pulse.
• Tremor and heat intolerance.
• Weight loss despite good appetite.
• Irritable, anxious temperament.
• Exophthalmos with staring eyes.
• Good response to low‑dose antithyroid drugs.

Iodium –

• Sudden onset after iodine excess.
• Burning sensation in throat, goitre.
• Palpitations, tremor, restlessness.
• Profuse sweating, especially on head.
• Sensitivity to light and noise.
• Improves with low‑iodine diet.

Calcarea Carbonica –

• Weakness, heaviness of limbs, especially in cold.
• Slow metabolism signs mixed with hyper‑features (palpitation, anxiety).
• Tendency to develop goitre.
• Craving for eggs, dairy, cold drinks.
• Aversion to cold air, feels chilly.
• Helpful when patient is fatigued and easily exhausted.

Natrum Muriaticum –

• Prominent eye signs (exophthalmos, lid lag).
• Emotional distress, grief, secretive nature.
• Palpitations with feeling of “fluttering”.
• Dry, cracked skin, especially on hands.
• Tendency to develop ulcers in stomach.
• Improves with emotional support and avoidance of salty foods.

Spongia Tosta –

• Sudden attacks of palpitation with choking sensation.
• Cough with dry, barking sound, especially at night.
• Tremor that worsens on exertion.
• Heat intolerance, profuse sweating.
• Anxiety with fear of losing control.
• Useful when symptoms are triggered by cold wind.