Hi everybody!
I'm back for my VLOG and today I am going to talk to you about HYPERthyroidsm or and
overactive thyroid.
As you know, I have recently spoken about HYPOthyroidism, an under active thyroid and
much of the detail about the thyroid; what it is, where it is, what it does, is in that
video.
So i will give you a very short synopsis in this video, so as not to bore you!
The thyroid gland is at the front of the neck, here.
And, it's crucial to just about everything in the body.
It produces two hormones: T4 which is called Thyroxine and T3, tri-iodothyronine.
Both of those hormones are crucial in our body and T3 is the more active one.
So what it does is control the rate at which everything that happens within your body,
goes on.
So, .how fast your heart beats, your brain works, your hair grows, your gut functions,
your skin turns over, how hot you are, your metabolism.
So it is the engine - the control centre of your body if you like.
So, when the thyroid goes wrong, whether its hypo or hyper its crucial and devastating
for the people that are affected.
Its a disease of women, so 1 in 50 women are affected by thyroid problems and 1 in 1000
men.
So, whats the cause of an over active thyroid?
Well, lots of things can make the thyroid go wrong.
The most common cause is a disease called Graves Disease.
And thats an auto-immune condition where antibodies in your body, in your own immune system start
attacking the thyroid and stimulate it to make more thyroid hormone.
So essentially you produce too much hormone in Graves disease.
About three quarters of all hyperactivity of the thyroid gland is caused by Graves disease.
And its kind of the opposite to Hashimotos which is also an autoimmune thyroid condition
which causes hypothyroidism.
Then outside of that you can have what we call a toxic nodular goitre and this is where
your thyroid gets swollen with lots and lots of small nodules.
And they can all stimulate the thyroid and make it produce too much hormone.
When people have that kind of goitre you can generally see it at the front of their neck.
You can have a solitary toxic adenoma.
Thats a lump, it's not a cancer, its a single lump in the thyroid which is causing the thyroid
to overwork.
You can have thyroiditis, which essentially means, inflammation of the thyroid.
Lots of different things can cause that, but in so doing they cause the thyroid to produce
too much hormone.
Some thyroid cancers can actually cause the thyroid to produce too much hormone.
Sometimes too much iodine can affect, or too little, can affect the thyroid.
So this is really really rare.
The thyroid uses iodine to make its thyroid hormones and so if you have too much iodine
in your diet, essentially it could cause the thyroid to produce to much, but as I said,
its really rare.
Some medications that we use for heart problems or mental health conditions like amiodorone,
lithium can actually stimulate the thyroid to produce too much or can actually cause
it to make too little.
So certainly some drugs are important and the effect that they have on the thyroid,
and we have to watch that really carefully when we prescribe those drugs.
And then finally the pregnancy hormone HCG can also stimulate the thyroid and thats why
some pregnant women get a thyroiditis or over active thyroid whilst they're pregnant.But
we can also see HCG produced by some cancers, sometimes for example, when a man has a testicular
cancer, that can produce HCG and in turn that can stimulate the thyroid to produce too much
hormone.
So those are the conditions that cause an overactive thyroid.
Now I mentioned that it was really important so what are the symptoms that you get when
you have an overactive thyroid?
Well, in stimulating all of those different parts around the body, including the heart,
you can get palpitation.
Thats the heart beating really fast and sometimes it can beat irregularly as well, and thats
dangerous for lots of reasons.
From the heart getting worn out, tired, from the risk of stroke when it's irregular.
You can get insomnia, sweating, you can get weight loss and still have an increased appetite,
be eating lots.
And this is where I get really cross, because I don't have a thyroid so I have to take artificial
thyroid and when people say to me 'oh thats fabulous, it must be really easy for you to
stay so skinny'!
Its so maddening, because when I go through the list now of the things that happen when
you've got too much thyroid, its a horrible place to be.
So along side those you can have a heat intolerance, so everybody else is cold and you are boiling
and sweating.
Diarrhoea and loose bowels to the point where you are running to the toilet all of the time.
Thirst and going to urinate excessively as a result.
Muscle weakness, joint pain, mood swings and aggression and anxiety.
If you have a neck swelling that's pushing on your oesophagus or swallowing pipe so that
eating food, drinking and swallowing can be difficult, as can breathing.
Tiredness, loss of sex drive or libido, irritability....
all of these things can be caused when your thyroid hormone is just going crazy, when
you are hyperthyroid.
So believe me, I've been there and its a horrible place to be and nobody wants to be hyperthyroid.
There also can be some complications from being hyperthyroid.
So for example, in Graves disease, you can get thyroid eye disease.
And this is when the eyes actually push out from the head, so if you looked at somebody
from the side you would see a bulge in their eyes that you wouldn't see normally.
The eyelids get pulled back over the ball of the eye so you can see white around the
Iris that you shouldn't be able to see, along the top and the bottom, in a normal person.
They can get irritation and dryness and be very uncomfortable, so that just blinking
is painful.
And it can actually lead to double vision.
Hyperthyroidism in pregnancy can cause pre-eclampsia, premature birth and even miscarriage.
And then there is something called a 'thyroid storm' and this is a life threatening situation
and it's when the thyroid produces so much hormone it actually just takes over everything
in the body, causes a 'storm' as per the name.
And that in itself can actually be life threatening, dangerous.
So there are lots of complications from being in that situation as well.
So, how do we diagnose it?
Well, if someone came to me as a GP, describing some of the symptoms, even just one or two,
that you can get with hyperthyroidism, I would do a physical examination.
So, I would listen to their heart, take their blood pressure, have a feel of their neck,
do some tests to look at their eyes, assess how their eyelids are moving, have a look
at the skin on their legs, test their muscles for strength or weakness.
And just do a complete physical.From there we would do some bloods.
So we would look at those hormones; T4, T3.
And also the thyroid stimulating hormone (TSH) which is the hormone that comes from the pain
and tells the thyroid to increase its production of the hormones.
And, quite often we'll see that, in someone who is hyperthyroid, the T4 and T3 are really
high and the TSH (the thyroid stimulating hormone) can be low or undetectable.
But, conversely, as with all of these things in medicine, it could also be really high
and could be the driving force making the thyroid produce so much hormone.
So the blood tests are really useful.If I am worried about there being a lump, many
lumps, a cancer in the thyroid, we would do an ultrasound scan and that could be accompanied
by a Fine Needle Aspiration where the person doing the ultrasound puts a needle into the
lump or one of the lumps to see what it is.
To see if its benign or cancerous.
We could even do a radioactive iodine scan, an uptake scan.
And I will talk about radioactive iodine later.
So essentially those are the tests you will possibly have if you are suspected of having
and overactive thyroid.
So what is the treatment?
Well, as always in medicine its medication, surgery or radioactive iodine.
Theres not really an option with an overactive thyroid of doing nothing because its dangerous.
So starting with medication, the initial aim, if you're hyperthyroid, is to actually calm
down the symptoms so that we take the strain off your heart and make you feel a little
bit better and then to control the amount of thyroid hormone that the thyroid gland
is producing.
So we do that in two ways.
So we calm down the heart with a blood pressure tablet called a beta blocker and it slows
the heart rate, it reduces blood pressure and hopefully helps control the palpitations.
And you can get on top of those things quite easily and quite quickly.
So the first medication that your GP will go to, or your endocrinologist, will be a
beta-blocker usually one called propranolol.
After that we then have medications called thionamides and these actually block the thyroid
gland from producing hormone so they quite quickly take down the amount of hormone that
the thyroid gland is producing to hopefully get it to a normal place.To the amount of
thyroid hormone that your body actually needs, rather than too much.
These are called Propylthiouracil or carbamizole and we use those in combination with a beta
blocker.
Now, there are two ways that these are used.
One way is to just completely block the thyroid so that its not producing any thyroid hormone
at all.
And then we give thyroid hormone to the right amount for your body.
Thats called block and replace.
Or the other way is to calculate how much we need to give you to try and bring down
the amount of hormone that the thyroid is producing to the correct amount.
And that can take some tweaking but that also works very well.
For some people, where we're just controlling the amount of thyroid that they're working
on, if we get it right, they can stay on that dose for as long as they need to and that
can actually be long term.
For the patients that we use block and replace, after 6 months to a year, we may consider
withdrawing the drugs and seeing if the thyroid has gone back to normal.
And in some cases it will do that but in others it will become hyperactive again and so then
we have to decide what treatment we can use for the long term.
There are side effects with these medications as with all medications.
These are nausea, a headache, a rash, joint pains and quite a dangerous situation called
Agranulocytosis.
And this is am immune suppression situation where getting an infection can actually be
really dangerous, so you'll be warned to look out for the signs of that; a sore throat,
cold symptoms, a fever and to seek medical help immediately if you get any of those.
Its very rare but we need to let you know that it could happen so that you are alert
to the signs.
So thats medication.
I mentioned earlier on about radioactive iodine and using it in an uptake scan.
So, the thyroid makes thyroid hormone from iodine.
So if you deliver a radioactive substance into the body with iodine, it will be the
thyroid and some other mucous membranes that actually take it up and once there, if we
are using it as a scan we can see what the activity is int he thyroid to work out whats
going on.
But we also use it as a treatment, to treat hyperthyroidism and some other situations
as well.
So we deliver the radioactive iodine to the patient in a big enough dose that it is taken
up by the thyroid and the aim is to kill the thyroid tissue.
Because with enough radiation thats what happens.
You drink a capsule, somebody delivers it to you in a spacesuit and in a steaming cauldren
in a room thats lined with lead so that it doesn't hurt other people!
And, as I said, its taken up and absorbed by the thyroid.
It can take a few weeks to work and you might need medication until the results have been
achieved.
In that time you mustn't get pregnant for 6 months and if its a man, he mustn't father
a child for 6 months and that's essentially because the ovaries and the sperm making equipment
actually take up the radioactive iodine and can be harmful if you get pregnant with either
eggs or sperm that have been affected by the radiation.
So you need time to pass to actyually shed those cells so that there's no more radiation
left.
You can't use radioactive iodine for pregnant or breast feeding women or for people who
have thyroid eye disease because it can actually make it worse.
So, its not an exact science and if the aim is to kill all of your thyroid, you may need
more than one dose and you'll have a scan in-between to see how much tissue you have
left.
If the aim is to kill part of your thyroid so that you produce less hormone you may end
up still hyperactive in which case you'll need another treatment.
Or you may end up slightly hypothyroid in which case you'll need to take thyroid medication
for life.
And that's just a calculation thats done and its one of the risks of having radioactive
iodine.
Surgery is an option and we tend to use surgery if you've got a very large goitre with lots
of lumps i it that is pressing on your windpipe.
If you've got a cancer and we need to remove the cancer before we do other treatment.
If you've got severe eye problems so you can't have (should say radioactive iodine) or if
you can't have any of the treatments that i've listed before for various reasons.
And sometimes people end up having surgery when the other treatments have failed.
So there's quite a few reasons why people have surgery and they just take the thyroid
out from here.
You'll have a very small scar, as you can see.
It used to be a really big scar across here but now its tiny.
And thereafter, you'll need to take thyroid medication for life because you won't have
a thyroid.
So, as you can see, all of those treatments, whichever one is deemed to be right for you,
and that will be decided by your endocrinologist, if you're at the point where you are needing
radio-active iodine, thyroid blocking drugs or surgery.
All of these can leave you afterwards, either hypothyroid where you have a little bit of
your own thyroid gland working but not enough or completely hypothyroid because you have
no thyroid gland left.
And at that point, as I mentioned, you'll need to have thyroid medication, possibly
for the rest of your life, certainly if you don't have a thyroid at all.
So this is where you could hop over to the hypothyroidism video to understand about that
but I will just touch on how that is done.
So, if you need thyroid replacement therapy, thats done by tablet and its a synthetic hormone,
mainly in the UK it's T4 that you're given.
The body breaks T4 down into T3, in normal circumstances.And for the majority, probably
80% of people that works absolutely fine and with your GP you work together to find the
dose that works perfectly for you.
There are however a proportion of people, a big proportion, who don't make that transition,
they don't break down T4, synthetic T4, to T3 very well at all and they end up feeling
awful because of their hypothyroidism and they will feel equally as awful as when they
were hyperthyroid, thats the irony of this treatment.For those people, they find a combination
of synthetic T3 and T4works very well.
Unfortunately, in this country, the guidelines don't recommend T3, even though we have lots
and lots of case studies of people for whom it works beautifully, I am one of them!
And there is an NHS consultation going on at the moment, where the government are looking
to take the T3 off of the prescribing list for GP's and that means people like me will
have it withdrawn and I won't be able to function without it.
I couldn't function before, I won't be able to be a GP, I won't be able to do normal things
in life, I wont be able to go about looking after my family.
All of those things we take for granted.
So its a really really serious situation.
There is a petition and I will put a link to it below as I did with hypothyroidism.
And there is also the NHS consultation which closes on the 21st October, although we are
hearing reports that they have already made their decision!
But please, fill out the consultation, you can just tick off LIOTHYRONINE which is the
T3 hormone - and then you don't have to answer all of the other questions.
And, you know, give support to those people who really can't function without it, and
if thats you, i'm sure feel as strongly as me about it, and I do feel very strongly about
it!
So, those are the treatments that are available at the moment.
Please do sign that petition and do the consultation, it doesn't take long; I have done it.
And I hope today that I have shown you that the thyroid is a crucial gland, its really
important, its bad if it goes wrong; being too high or too low.
There are solutions and I have given those to you.
None of them are simple, all have side effects and long term repercussions but there are
answers and there is medication.
And there is medication that everybody at the moment can feel well on although that
could change in the near future.
So I hope you've enjoyed the video.
Please ask me questions afterwards, I always answer them, as you've seen.
Please make suggestions for future videos and I will see you in a couple of weeks with
my next VLOG.
Thanks for listening!