Hyperthyroidism and Graves’ Disease

 

What Is the Thyroid?

The thyroid is a small gland below the skin and muscles at the front of the neck, at the spot where a bow tie would rest.

It’s brownish red, with left and right halves (called lobes) that look like a butterfly’s wings. It weighs less than an ounce, but helps the body do many things, such as get energy from food, grow, and go through sexual development.

What Is Hyperthyroidism?

Thyroid hormone problems happen when the thyroid gland makes either too much or too little hormone for the body.

If the thyroid is overactive, it releases too much thyroid hormone into the bloodstream, causing hyperthyroidism. The body use up energy more quickly than it should, and chemical activity (like metabolism) in the cells speeds up.

If the thyroid is underactive, it makes too little thyroid hormone, causing hypothyroidism. The body uses up energy more slowly, and chemical activity (metabolism) in the cells slows down.

What Are the Signs & Symptoms of Hyperthyroidism?

High thyroid hormone levels (hyperthyroidism) can cause:

  • nervousness
  • irritability
  • increased sweating
  • bulging eyes
  • trouble sleeping
  • a fast heartbeat
  • irregular menstrual periods in girls
  • weight loss

Sometimes the thyroid gland grows and forms a bulge in the neck called a goiter.

Medicines and other techniques can effectively treat hyperthyroidism. It’s important to work with an

(a doctor who specializes in hormone problems) or other doctor who knows how to treat thyroid conditions.

What Causes Hyperthyroidism?

The three main causes of hyperthyroidism are:

  1. Graves’ disease. This is the most common cause of hyperthyroidism in children. It happens when the body produces antibodies that make the thyroid gland overactive. Antibodies usually help the body fight infection, but these antibodies stop the body from controlling the thyroid gland correctly (like a car without brakes). As a result, the thyroid hormone levels in the blood can get very high. Doctors don’t know why the body starts making these antibodies. Graves’ disease can affect health for the rest of a person’s life. So it’s important to get medical treatment to control it.
  2. Thyroid gland inflammation (thyroiditis). This causes the thyroid gland to leak too much thyroid hormone into the blood. Thyroiditis can be caused by a lots of things — for example, a blow to the thyroid gland, infections, and
    diseases (like Hashimoto’s thyroiditis). Hyperthyroidism from thyroiditis usually lasts for a few months and then gets better on its own. The thyroid usually recovers, but sometimes is damaged and can’t work normally again. This causes hypothyroidism (underactive thyroid).
  3. Thyroid nodules (growths in the thyroid gland). These can sometimes make large amounts of thyroid hormones, causing symptoms of hyperthyroidism. Overactive thyroid nodules are usually large (an inch or more in size) and can be big enough to feel in the neck. Most overactive thyroid nodules are
    and treated with surgery.

What Are the Signs & Symptoms of Graves’ Disease?

Kids and teens with Graves’ disease might notice that:

  • they’re more tired than usual
  • they have lots of trouble sleeping
  • they lose weight
  • their heart is beating very fast
  • their hands shake (called tremor)
  • they have a lot of trouble focusing

Girls with Graves’ disease sometimes notice that they have fewer (or less regular) menstrual cycles. Over time, many people notice that their thyroid glands are enlarged.

Some people with Graves’ disease have troubles with their eyes — itching, burning, redness, and sometimes trouble seeing normally. Sometimes they feel pressure behind the eyes, feel their eyes bulging, or see double. This is because the antibodies that make the thyroid overactive also cause

and swelling behind the eyes. When this happens, it’s called Graves’ eye disease.

How Is Graves’ Disease Diagnosed?

Graves’ disease is diagnosed based on a visit with a doctor who will review the symptoms and examine the patient.

It’s important to do lab tests too, because many people can have some of the symptoms of hyperthyroidism for other reasons. Sometimes the blood tests aren’t enough to be sure of the diagnosis and other tests are needed, like a thyroid scan or ultrasound.

How Is Graves’ Disease Treated?

Doctors usually treat Graves’ disease with anti-thyroid medicines. These medicines slow the release of thyroid hormones from the gland. They usually bring hormone levels down to normal within a couple of months.

Many people with Graves’ disease need to take anti-thyroid medicines for a long time to control the condition — sometimes for the rest of their lives.

Some might need other treatment if anti-thyroid medicines don’t help or cause side effects, or if the disease is very hard to control. In these cases, two permanent treatment options can be used: radioactive iodine treatment and surgery.

Radioactive iodine (RAI) is the most commonly used permanent treatment for Graves’ disease. RAI damages the thyroid gland so that it can’t make too much thyroid hormone. This doesn’t harm other parts of the body. The RAI treatment is taken in capsules or mixed with a glass of water. The thyroid gland quickly absorbs the RAI from the bloodstream and, within a few months, the gland shrinks and symptoms slowly disappear.

Surgery to remove most of the thyroid gland is called a thyroidectomy. It’s done in a hospital under general anesthesia, so the person is asleep and feels nothing. A small incision (cut) in the lower central part of the neck usually leaves a thin scar. It’s common to have some pain for a few days after the surgery, but most people feel much better within a few days.

After treatment for hyperthyroidism, hormone production often slows down to hypothyroid (underactive) levels. So the person needs to take a thyroid hormone replacement tablet each day. This treatment is a lot easier to manage than taking pills to control the hyperthyroidism — fewer blood tests, doctor visits, and medicine changes are needed.

As the body adjusts to the hormone replacement tablets, a doctor may increase or reduce the dosage until the levels of thyroid hormone are normal. When the doctor finds the proper dosage, people usually feel well and free of symptoms. The doctor will continue to check hormone levels to make sure the dosage is right, especially for growing teens whose levels might change over just a few months.

What Else Should I Know?

We don’t know why people develop Graves’ disease. But with good medical help, kids and teens can be healthy and do all the things other kids and teens can do.

Graves’ eye disease can develop at any time in someone who has Graves’ disease. Smoke can make this eye disease much worse, so it’s very important to not smoke and to avoid secondhand smoke.

Women with Graves’ disease need to be very careful to keep their hormone levels in balance. Uncontrolled thyroid hormone levels in a pregnant woman can lead to problems during pregnancy and harm her baby.

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Hypothyroidism and Hashimoto’s Thyroiditis

 

What Is the Thyroid?

The thyroid is a small gland below the skin and muscles at the front of the neck, at the spot where a bow tie would rest.

It’s brownish red, with left and right halves (called lobes) that look like a butterfly’s wings. It weighs less than an ounce, but helps the body do many things, such as get energy from food, grow, and go through sexual development. In younger children, it is also important for brain development.

What Is Hypothyroidism?

Hypothyroidism (or underactive thyroid) is when the thyroid gland doesn’t make enough of some important hormones. This makes the body use up energy more slowly, and chemical activity (metabolism) in the cells slows down.

Hypothyroidism is a common condition, especially in adult women. But kids can have it too. Some children are born with it — this is called congenital hypothyroidism. Others develop it later, usually late in childhood or as teens. The most common cause of hypothyroidism in kids and teens is the

disease Hashimoto’s thyroiditis.

What Are the Signs & Symptoms of Hypothyroidism?

A person with mild hypothyroidism may feel just fine — in fact, it might cause no symptoms at all.

But if thyroid hormone levels get too low, symptoms can become more obvious. These include:

  • sluggishness
  • depression
  • dry skin or hair loss
  • feeling cold
  • muscle weakness
  • poor memory or trouble concentrating
  • constipation
  • facial puffiness
  • weight gain (even when not eating more or exercising less)
  • slowed growth
  • slow sexual development
  • irregular menstrual periods in girls

What Is Hashimoto’s Thyroiditis?

Hashimoto’s thyroiditis (hah-she-MOE-toes thy-roy-DYE-tiss) is an autoimmune disease. It causes most cases of hypothyroidism in kids and teens. Hashimoto’s thyroiditis is also called
lymphocytic thyroiditis.

What Happens in Hashimoto’s Thyroiditis?

Hashimoto’s thyroiditis is an ongoing condition in which the immune system attacks the thyroid. Often, this prevents the thyroid from making enough thyroid hormone, causing hypothyroidism. The body responds by sending a message to the thyroid to work harder to make enough hormone.

This, and the swelling the immune system causes as it attacks the gland, can make the thyroid get bigger, leading to a goiter. The thyroid can keep changing size over months or years. Surgery is sometimes done to treat goiters, especially if the thyroid is big enough to cause problems with swallowing. But this is rarely needed in children.

How Are Hypothyroidism and Hashimoto’s Thyroiditis Diagnosed?

To diagnose hypothyroidism and Hashimoto’s thyroiditis, doctors ask about a person’s symptoms, do a physical exam, and order blood tests. The tests measure:

  • thyroid hormone levels, particularly thyroxine (T4) and thyroid-stimulating hormone (TSH). TSH is a hormone made in the
    (a pea-sized gland just beneath the brain). More TSH is released into the blood when the brain and pituitary sense that the levels of thyroid hormone in the blood are too low. TSH stimulates the thyroid to work harder to make more thyroid hormone.
  • some antibodies (proteins made by the immune system). High levels of these antibodies in the blood are a sign that the gland is being attack by the immune system in Hashimoto’s. The two antibodies commonly measured are thyroglobulin antibodies (TgAb) and thyroid peroxidase antibodies (TPO).

How Are Hypothyroidism and Hashimoto’s Thyroiditis Treated?

Doctors treat an underactive thyroid with daily thyroid hormone replacement pills. These will bring the body’s levels of thyroid hormone back to normal.

This treatment is fairly simple, but a person will have doctor visits several times a year for an exam, blood tests, and medicine changes as needed.

What Else Should I Know?

In rare cases, the immune system of a child with Hashimoto’s can cause

in the brain and nervous system. Symptoms can include strange behavior, confusion, muscle twitching, and seizures.

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Thyroid Tests

 

What Is the Thyroid?

The thyroid is a small gland below the skin and muscles at the front of the neck, at the spot where a bow tie would rest. It makes two types of thyroid hormones: T3 (triiodothyronine) and T4 (thyroxine). It helps the body do many things, such as get energy from food, grow, and go through sexual development.

The pituitary is a pea-sized gland at the bottom of the brain that makes thyroid stimulating hormone (TSH). TSH triggers the thyroid to make more thyroid hormone. The pituitary gland and the thyroid gland send messages back and forth to each other about how much hormone to make to keep the levels normal.

What Is Thyroid Disease?

Some diseases of the thyroid or pituitary gland cause the thyroid to make too much or too little thyroid hormone:

  • If the thyroid is overactive, it releases too much thyroid hormone, causing hyperthyroidism. The body use up energy more quickly than it should, and chemical activity (like metabolism) in the cells speeds up. Symptoms include sweating, trembling, weight loss, and fast heartbeat.
  • If the thyroid is underactive, it makes too little thyroid hormone, causing hypothyroidism. The body uses up energy more slowly, and chemical activity (metabolism) in the cells slows down. Symptoms include tiredness, feeling cold, constipation, dry skin, and slow height growth in children.

What Are Thyroid Blood Tests?

Doctors use blood tests to check for thyroid or pituitary problems. In kids already diagnosed with thyroid or pituitary problems, the tests are used to guide treatment.

Commonly ordered thyroid blood tests include:

  • T4 test: This is done to measure the blood level of the hormone T4 (thyroxine). It might be done in one or both of the following ways:
    total T4, which measures the entire amount of thyroxine in the blood, including the amount attached to blood proteins that help carry the hormone through the bloodstream
    free T4, which measures only the thyroxine that’s not attached to proteins. This is the part of T4 in the blood that affects how the body’s cells work.
    The results of the T4 blood tests can help diagnose hyperthyroidism or hypothyroidism and guide treatment.
  • TSH test: A thyroid stimulating hormone (TSH) test can help tell how well the thyroid is working. If a thyroid disease prevents the gland from making enough thyroid hormone, the pituitary gland releases more TSH into the blood. If the thyroid is making too much thyroid hormone, the pituitary releases less TSH, which can lower the levels of TSH in the blood.
  • T3 total test: The T3 total test measures the other major thyroid hormone in the blood. It’s particularly useful in diagnosing hyperthyroidism.
  • thyroid antibodies test: Hashimoto’s thyroiditis is an
    condition in which the immune system attacks the thyroid gland. To diagnose it, doctors check for high levels of antibodies that are a sign of the immune system’s attack on proteins in the thyroid gland. Usually, two types of thyroid antibodies are measured: thyroglobulin antibodies (TgAb) and thyroid peroxidase antibodies (TPO).

In some cases, abnormal thyroid test results can be due to a medicine, an ongoing medical condition, or pregnancy. In these cases, there may be nothing wrong with the thyroid or pituitary glands themselves.

The normal ranges of thyroid function test results vary by age. Doctors think about this carefully when they interpret them.

What if I Have Questions?

If you have any questions about a thyroid blood test, speak with your doctor. You can also talk to the technician who’s doing the blood draw before the procedure.

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