Signs and Symptoms

• Rapid heart rate and palpitations
• Shortness of breath
• Goiter (swelling of the thyroid gland)
• Moist skin and increased perspiration
• Shakiness and tremors
• Anxiety
• Heat intolerance and sweating
• Increased appetite accompanied by weight loss
• Insomnia
• Irritability
• Swollen, reddened, and bulging eyes (in Graves disease)
• Occasionally, raised, thickened skin over the shins, back of feet, back, hands, or even face
• In crisis: fever, very rapid pulse, agitation, and possibly delirium
• Changes in menstrual periods
• Difficulty concentrating

What Causes It?

Researchers suspect that Graves disease (the most common form of hyperthyroidism) is caused by an antibody that mistakenly stimulates the thyroid to produce too much hormone. Graves disease is associated with many autoimmune diseases, including type 1 diabetes, rheumatoid arthritis, and lupus. Toxic nodular goiter is caused by a noncancerous tumor in nodules that make up the thyroid gland. Secondary hyperthyroidism results when the pituitary (a small gland located at the base of the brain that regulates the release of hormones from several other glands) overrides the thyroid's normal instructions, and orders it to make too much thyroid hormone. Other causes include excessive thyroid hormone taken to treat hypothyroidism.

What to Expect at Your Doctor's Office

Your doctor will ask you to extend your fingers to see if you have an obvious tremor. Your doctor will also examine your thyroid gland while you swallow. A blood test can confirm that you have elevated levels of thyroid hormone. Your doctor may also order a radioactive iodine uptake test to determine why your thyroid is producing too much hormone.

Treatment Options

Drug Therapies

Your doctor will most likely prescribe a single dose of liquid radioactive iodine, which calms down your thyroid gland. Often the thyroid then becomes underactive. Up to half of patients who receive radioactive iodine treatments for an overactive thyroid develop permanent hypothyroidism within a year of therapy. Such patients may have to take replacement thyroid hormone. Alternatively, your doctor may give you thyroid depressive medication. Your doctor may also prescribe beta-blockers to help slow a rapid heartbeat. If drug treatment fails, you may need surgery to remove part of your thyroid. If so, you will need to take replacement thyroid hormone.

Complementary and Alternative Therapies

Alternative therapies may be effective at minimizing symptoms of mild thyroid dysfunction. Keep your doctors informed about any complementary or alternative treatment (CAM) you are taking. Some CAM therapies can interfere with conventional medical therapies. Work with a provider who is knowledgeable in complementary medicine to find the right mix of treatments for you. If you are pregnant, or thinking about becoming pregnant, do not use any CAM therapies unless directed to do so by your physician.

Following these nutritional tips may help reduce symptoms:

• Eliminate suspected food allergens, such as dairy (milk, cheese, and ice cream), wheat (gluten), soy, corn, preservatives, and chemical food additives. Your doctor may want to test you for food allergies.
• Eat foods high in B-vitamins and iron, such as whole grains (if no allergy), fresh vegetables, and sea vegetables.
• If you take thyroid hormone medications, talk to your doctor before consuming soy products. Some evidence suggests that soy may interfere with absorption of thyroid hormone.
• Iron may also interfere with the absorption of thyroid hormone medication.
• Eat antioxidant-rich foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell pepper).
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, or beans for protein. Limit your intake of processed meats, such as fast foods and lunch meats.
• Use healthy cooking oils, such as olive oil or coconut oil.
• Reduce or eliminate trans fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid alcohol and tobacco. Talk to your doctor before using caffeine-containing products, such as tea and soft drinks. Caffeine impacts several conditions and medications.
• Exercise, if possible, 30 minutes daily, 5 days a week.

You may address nutritional deficiencies with the following supplements:

• A daily multivitamin. Containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil. To help reduce inflammation and boost immunity. Omega-3 fatty acids can have a blood-thinning effect. If you are taking blood-thinning medications, speak to your doctor before taking Omega-3 fatty acids.
• Vitamin C. Aas an antioxidant and for immune support.
• Alpha-lipoic acid. For antioxidant support. Can potentially interfere with certain chemotherapy agents. Alpha-lipoic acid may be dangerous in people with low thiamine levels, a condition commonly seen in alcoholics.
• L-carnitine. For decreasing thyroid activity. May have blood-thinning effects and therefore increase anticlotting effects of certain medicines, such as warfarin (Coumadin). L-carnitine may increase the likelihood of seizures in people with a history of seizures.
• Probiotic supplement (containing Lactobacillus acidophilus). When needed for maintenance of gastrointestinal and immune health. Some acidophilus products may need refrigeration. Read labels carefully. If you are immune compromised, or if you take immune-suppressive drugs, speak with your physician before taking probiotic supplements.
• DO NOT take an iodine supplement unless directed by your doctor. Iodine is only effective in cases of iodine deficiency, which is uncommon in developed countries. Excessive iodine can cause hypothyroidism.

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your doctor before starting treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). People with a history of alcoholism should not take tinctures. Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures singly or in combination as noted. If you are pregnant or nursing, speak to your doctor before using any herbal products.

• Green tea (Camellia sinensis). Standardized extract, for antioxidant effects. Use caffeine-free products.
• Lemon balm (Melissa officinalis). To normalize an overactive thyroid. Steep 2 tbs. lemon balm in 1 cup of boiling water. Strain and cool.

Avoid the following herbs:

• Bladderwrack ((Fucus vesiculosus)). It may stimulate hyperthyroidism.
• Ashwaganda (Withania somminfera). There has been some debate about whether ashwaganda also stimulates hyperthyroidism. Some herbalists may still recommend ashwaganda in hyperthyroid patients. Consult a trained herbal practitioner for advice.
• Caffeinated green tea products and Chinese or Korean ginseng (Panax ginseng). These herbs are too stimulating.

Few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider remedies for the treatment of symptoms based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account your constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for you.

Acupuncture may help correct hormonal imbalances.

Therapeutic massage may help relieve stress.

Special Considerations

Thyroid problems during pregnancy can cause serious complications. Some patients with hyperthyroid disease experience a decline in bone mineral density. This can be reversed after treatment for hyperthyroidism.

Complications of hyperthyroidism include irregular heart beats (atrial fibrilation), heart disease, and osteoporosis. Untreated Graves disease can also lead to vision loss and blindness.

Supporting Research

Atis G. Hyperthyroidism: a risk factor for female sexual dysfunction. J Sex Med. 2011;8(8):2327-33.

Bagnasco M, Bossert I, Pesce G. Stress and autoimmune thyroid diseases. Neuroimmunomodulation. 2006;13(5-6):309-17.

Bahn R, Levy E, Wartofsky L. Graves' disease. J Clin Endocrinol Metab. 2007;92(11):2 p following 14A.

Bope ET, Kellerman RD, eds. Conn's Current Therapy 2014. 1st ed. Philadelphia, PA: Elsevier Saunders; 2013.

Dominguez LJ, Bevilacqua M, Dibella G, et al. Diagnosing and managing thyroid disease in the nursing home. J Am Med Dir Assoc. 2008;9(1):9-17.

Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015.

Ferri FF. Ferri's Clinical Advisor 2014. 1st ed. Philadelphia, PA: Elsevier Mosby; 2013.

Fumarola A. Therapy of hyperthyroidism in pregnancy and breastfeeding. Obstet Gynecol Surv. 2011;66(6):378-85.

Ho CH, Chang TC, Guo YJ, Chen SC, Yu HJ, Huang KH. Lower urinary tract symptoms and urinary flow rates in female patients with hyperthyroidism. Urology. 2011;77(1):50-4.

Klein I, Danzi S. Thyroid disease and the heart. Circulation. 2007;116(15):1725-35.

Nayak B, Hodak SP. Hyperthyroidism. Endocrinol Metab Clin North Am. 2007;36(3):617-56, v. Review.

Nygaard B. Hyperthyroidism. Am Fam Physician. 2007;76(7):1014-6.

Vanderpas J. Nutritional epidemiology and thyroid hormone metabolism. Annu Rev Nutr. 2006;26:293-322.

Van de Ven AC, Erdtsieck RJ. Changes in bone mineral density, quantitative ultrasound parameters and markers of bone turnover during treatment of hypothyroidism. Neth J Med. 2008;66(10):428-32.

Wu P. Thyroid disorders and diabetes. It is common for a person to be affected by both thyroid disease and diabetes. Diabetes Self Manag. 2007;24(5):80-2, 85-7.

Yuan L, Tian Y, Zhang F, et al. Impairment of attention networks in patients with untreated hyperthyroidism. Neurosci Lett. 2014;574:26-30.