Hyperthyroidism: Symptoms and Treatments
Guest: Dr. Kathie Hermayer – Medicine/Endocrinology, Diabetes & Medical Genetics
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Kathie Hermayer, an endocrinologist. We’re going to be talking about hyperthyroidism today. Just what is hyperthyroidism?
Dr. Kathie Hermayer: Hyperthyroidism is an overproduction of thyroid hormone by the thyroid gland.
Dr. Linda Austin: So, what happens when that hormone is overproduced?
Dr. Kathie Hermayer: The changes that can occur in the body are vast. What can occur when somebody has hyperthyroidism is an increased heart rate, weight loss, anxiety, feeling hot all the time, trouble sleeping. If it’s a menstruating female, they can have their periods more spread apart, diarrhea, smooth skin, and a tremor, shaking.
Dr. Linda Austin: I, one time, was told by a physician, when we’re talking about somebody with hyperthyroidism, that you virtually never see it unless the pulse is elevated, unless there’s a rapid heart rate. Is that true?
Dr. Kathie Hermayer: Not entirely. People can have something called subclinical hyperthyroidism, where they don’t necessarily have the signs and symptoms of hyperthyroidism, but their lab data looks hyperthyroid.
Dr. Linda Austin: So, are those people who are in the early stages of hyperthyroidism then?
Dr. Kathie Hermayer: Correct.
Dr. Linda Austin: And might they have some subtle manifestations of it, like irritability, for example, or feeling hot?
Dr. Kathie Hermayer: Correct. With subclinical hyperthyroidism, we can see bone loss, so, early than expected osteoporosis. And sometimes you can see heart arrhythmias, or atrial fibrillation, where somebody has an irregular pulse.
Dr. Linda Austin: What causes hyperthyroidism?
Dr. Kathie Hermayer: There are different causes of hyperthyroidism. Probably one of the most common causes is Graves’ disease, which is an autoimmune disorder whereby the body creates antibodies to make the thyroid gland overproduce thyroid hormone. There are other causes of hyperthyroidism, such as a goiter, where the gland can be enlarged in the neck and then there can be certain nodules in that gland that oversecrete thyroid hormone.
Dr. Linda Austin: But goiter is not necessarily hyperthyroid.
Dr. Kathie Hermayer: That’s correct. You can have cases of what we call nontoxic goiter or an enlarged gland in someone’s neck where they have normal thyroid hormone but they have an enlarged gland.
Dr. Linda Austin: So, it sounds a little complicated then. I remember a physician once saying to me that the thyroid gland does not read the text book, meaning that abnormalities can present in a lot of different ways.
Dr. Kathie Hermayer: Yes. And what I tell my patients is that thyroid disease can be two sides of the same coin. So sometimes they could be feeling hyperthyroid, but they could actually be hypothyroid, and vice versa. So even though they have classical signs and symptoms of hyperthyroidism, that I mentioned earlier, somebody could actually have symptoms of hypothyroidism and be hyperthyroid. That’s something we can actually see in the elderly. We have a condition in the elderly called apathetic hyperthyroidism, where the person appears to be slow thyroid but they’re actually hyperthyroid.
Dr. Linda Austin: How do you evaluate a person for hyperthyroidism after you’ve gotten the blood drawn and you know clinically that it’s there? Do you do other diagnostic studies beyond that?
Dr. Kathie Hermayer: After you draw the blood, what you generally tend to look for is a low TSH level and elevated peripheral numbers. And those peripheral numbers are generally a free T3 and a free T4 level. Once you have a clinical diagnosis confirmed by a laboratory, and if you want to determine if that patient may have more of Graves’ disease or a toxic goiter, so to speak, then you could proceed further by doing something called a thyroid scan and uptake. Sometimes we may even consider doing a thyroid ultrasound on a patient, depending on what we’re looking for.
Dr. Linda Austin: And then how do you do that?
Dr. Kathie Hermayer: What I tell my patients with hyperthyroidism is that there are three main modes of therapy. One is generally to give them medication to slow down the thyroid hormone production, and that’s something we call thioamides. And the two drugs we have available in this country are Methimazole, as well as Propylthiouracil, PTU. Methimazole is Tapazole. The other mode of therapy we have is radioactive iodine ablation, where a patient can drink a pill, and that pill, over time, will slowly kill off the cells of the thyroid gland. And then the third option, we reserve for patients, usually, with very severe cases of hyperthyroidism, is surgical removal of the thyroid gland. Frequently we give patients something called beta blockers in addition to their thyroid hormone therapy to try to slow their heart down and bring down their pulse rate.
Dr. Linda Austin: It sounds to me as if, for both hypo and hyperthyroidism, although these can be very serious diseases that affect all sorts of organs of the body, you also are quite successful in treating both conditions, that these are highly treatable conditions. Is that correct?
Dr. Kathie Hermayer: Yes, it is.
Dr. Linda Austin: How nice to be an endocrinologist and have that kind of success with your patients. As a psychiatrist, I have to say that it must be very nice.
Dr. Kathie Hermayer: It is.
Dr. Linda Austin: Dr. Hermayer, thank you so much for talking with us today.
Dr. Kathie Hermayer: Thank you.
If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection: (843) 792-1414.