Causes, signs, and treatments for hyperthyroidism

When the thyroid gland makes too much of the thyroid hormones thyroxine and triiodothyronine, this is called hyperthyroidism. What can cause this, what effects it can have, and how it can be treated? [1]

In short, hyperthyroidism

Hyperthyroidism is the name for a condition in which the thyroid makes too many hormones.

Graves’ disease and something called autonomy are the two main causes.

Because thyroid hormones do so many different things, the symptoms can be very different. Restlessness, tremors, a fast heartbeat, weight loss, and excessive sweating are some examples.

Blood tests (such as the TSH value) and other tests can be used to find and classify hyperfunction.

Depending on the situation, the disease is usually treated with drugs, radioactive iodine, and/or surgery.

Learn more The Hypothyroidism Solution

What is a thyroid that works too hard?

The thyroid is an organ that looks like a butterfly and sits below the larynx. It is right next to the windpipe. Triiodothyronine (T3) and thyroxine (T4) are two important thyroid hormones that are made by the thyroid from protein and iodine. These are put into the blood, and this process is controlled by a hormone called TSH that is made in the pituitary gland.

Thyroid hormones have an effect on our mental health as well as our metabolism, blood flow, and growth. It is overactive if the thyroid makes too many hormones (hyperthyroidism). If the hyperfunction is caused by not getting enough iodine, the enlarged thyroid gland often sticks out in the neck area. This is called a “goiter” in everyday language. Women are mostly affected by it.

Important: People who have a thyroid that works too much should tell their doctors about it. If not, some examination methods, such as those that use contrast media with iodine, can cause problems. When giving out medicine, hyperthyroidism may also need to be taken into account.

How can a thyroid gland that works too much happen?

Different things can cause hyperthyroidism, but more than 95% of the time, it is caused by Graves’ disease (also called Basedow’s disease) or by autoimmunity.

Basesow’s illness (Morbus Graves)

An autoimmune disease is what this is. Different antibodies are made against the thyroid gland for reasons that are not yet clear. The most important (TSH receptor autoantibodies, or “TRAK”) stimulate the cells that make hormones, which causes more thyroid hormones to be made. Since this production isn’t based on what the body needs, the thyroid gland starts to work too hard. This is usually linked to an enlarged thyroid gland as well (goiter).

What is a goiter in the thyroid?

A goiter happens when the thyroid gland gets bigger. Most of the time, this is caused by a lack of iodine. Things you need to know

Graves’ disease is characterized by an autoimmune process that affects not only the thyroid gland but also the tissue around the eyes (endocrine orbitopathy) and the skin on the lower leg (pretibial myxedema) (see “Symptoms” section).[2]


Causes, signs, and treatments for Graves’ disease

Graves’ disease is when the thyroid gland works too much. The symptoms are different, and there are different ways to treat them.


Functional autonomy means that individual nodes or “autonomous adenomas” on the thyroid gland or the whole thyroid tissue can make hormones on their own. The pituitary gland no longer has control over the so-called autonomous areas (hypophysis). This can lead to hyperfunction if the body makes more hormones than it needs.

Most of the time, the healthy parts of the thyroid gland make less hormones to make up for the unhealthy parts. This means that hormone levels can be kept in check. If a person with Graves’ disease takes in too much iodine over a long period of time or takes certain medications, like contrast agents that contain iodine and are used in some imaging procedures, this can cause the diseased, uncontrolled areas to suddenly release too much thyroid hormone. When the hormone level gets into the red zone, it’s no longer possible to find a balance.

A long-term enlargement of the thyroid caused by a lack of iodine (iodine deficiency goiter or goiter) is often the cause of thyroid autonomy. One of the common but not always necessary side effects is that knots form. During a scintigraphy exam, it is common for autonomous nodules to be very active. These are called “hot nodules,” and they can tell you about how the thyroid tissue is working.

Self-examination of the thyroid

What are hot nodules and cold nodules?

Estimates show that almost a third of Germans have nodules on their thyroids. Why they sometimes need treatment and when they can be dangerous

Rarer causes

When the thyroid is inflamed, it can also temporarily make the gland work too hard. Hyperthyroidism is very rarely caused by tumors that make hormones, like thyroid tumors or tumors of the pituitary gland. In early pregnancy, if the placenta makes too much of a hormone called HCG, this can also cause a temporary hyperfunction, which is often accompanied by nausea and severe vomiting. When the dose of thyroid hormone therapy is too high, hyperthyroidism symptoms can also show up, but they go away when the dose is changed.

Learn more The Hypothyroidism Solution

What are the signs of a thyroid that is working too hard?

If your thyroid gland is too big, you might have trouble swallowing, a hoarse voice, or trouble buttoning your shirt. Thyroid nodules can show up as a lump or swelling in the front of the neck. Other possible signs of a thyroid that is working too hard are:

Nervousness, anger, restlessness, and trouble focusing


sleep disorders

High blood pressure, a strong pulse, and a heartbeat that is too fast (palpitations), and in the worst cases, heart rhythm problems that can kill you.

Even though I have a big appetite, I’ve lost weight.

Warm, wet skin, sweating, and not being able to handle heat

Hair loss , brittle nails


muscles that are weak and hurt

menstrual problems; less lust and potency

In Basedow’s disease, the lower legs swell up in a lumpy way (myxedema).

Basedow’s disease can cause problems with the eyes. These include tears, a feeling like there is something in the eye, sensitivity to light, a feeling of pressure (which can be painful), reddening of the conjunctiva, swelling of the eyelids, eyes that stick out (exophthalmos), and trouble seeing (often double vision)

This interactive graphic shows how the thyroid affects the body’s functions and what happens when it works too much or not enough:

Controlling how the thyroid works:



changes at


Restlessness, anger, mood swings, and being mean.


moods that are sad and a lack of focus when tired


changes at


A lot of conjunctivitis and shiny eyes.



skin, hair, nails

changes at


hair loss, soft rosy skin


dry pale skin, brittle nails


changes at


sweating, low lipids in the blood, and weight loss


freezing, high blood fats, and weight gain

cardiovascular system

changes at


Rapid heart rate and high systolic blood pressure


low heart rate, high blood pressure

the digestive system

changes at






changes at


Menstrual cycle disorders, miscarriages


Libido and fertility both go down, and potency gets weaker.

bone structure

changes at


bone loss, joint problems


a lot of broken bones that don’t heal well

muscles and nerves

changes at


shaky fingers, restlessness, weak muscles, and a lack of strength


unsteady walking, disturbed senses of taste and smell

Hyperthyroidism or a thyrotoxic crisis is a problem.

In a so-called “hyperthyroid crisis,” which doesn’t happen very often, the thyroid gland works very hard. This causes symptoms like fever, unusual weakness, and changes in consciousness. In the worst case, you could lose consciousness (thyrotoxic coma). There is a chance of heart and liver damage, and there is also a chance of dying. There needs to be quick and intense treatment.

X-ray contrast media or medicines that contain iodine can make hyperthyroidism even worse to the point of a thyrotoxic crisis. There is nothing wrong with the amount of iodine in food. Infections, injuries, surgery, stopping thyroid medication, and stressful situations can also cause a crisis, but only if you already have an overactive thyroid that is hard to treat.[3]

Ultrasound is a way to measure the size of the thyroid gland.

Ultrasound is a way to measure the size of the thyroid gland.


Most of the time, the first signs of a disease are what the patient tells the doctor. By feeling the neck, you can sometimes tell if the thyroid gland is getting bigger. The doctor can then confirm the suspicion by doing more tests, like taking blood samples and using imaging techniques like ultrasound and scintigraphy, to find out what’s going on.

blood tests

First, a value is set for the hormone TSH. The pituitary gland makes TSH, which controls how much thyroid hormone is made and when it gets into the blood. The concentration of the thyroid hormones can be measured at the same time or later. If the thyroid gland is overactive, the TSH value is usually below the normal range, while the thyroid hormone levels in the blood are either high (overt hyperthyroidism) or normal (latent or compensated hyperthyroidism). If the TSH level is normal, it is almost impossible for the thyroid to be too active. Normal serum TSH levels for adults are between 0.40 and 4.0 mU/l. Thyroid antibodies can be found in the blood of more than 90% of people with Basedow’s disease.[4]

A woman’s hand on her neck

MAK (TPO antibodies), TAK, and TRAK are all thyroid antibodies.

Autoimmune thyroid disease can cause sleeplessness, changes in weight, and other vague complaints.

thyroid exam

TSH stands for thyroid stimulating hormone.

The pituitary gland makes TSH, which is a hormone (pituitary gland). The value shows if the thyroid makes enough hormones and if it is too active or not active enough.

Getting an ultrasound

Using ultrasound, the size and shape of the shield nozzle are checked. The ultrasound can already give the doctor hints about what is causing the growth. Biopsies can also be done with a fine needle and ultrasound control if they are needed.

scintigraphy of the thyroid

If the ultrasound results aren’t normal, like if the thyroid has grown or changed into nodules, a thyroid scintigraphy functional test can show how and how much the thyroid absorbs iodine. The patient’s vein is injected with something that gives off radiation. In cases of hyperfunction, either the whole thyroid gland or just certain spots (“hot nodes”) tend to absorb the marked substance more.

More research is needed.

In some cases, a computer tomography of the neck, X-rays of the trachea, or a color ultrasound examination of the thyroid gland may be needed to find out more about how bad the disease is and what caused it.

Learn more The Hypothyroidism Solution

The results of the investigation for common causes

If hyperfunction is confirmed, the causes must be figured out. Here, the following is true:

Autonomy: A clear and nodular enlargement of the thyroid and an older age make you think of autonomy. Most of the time, the ultrasound shows changes that are more or less noticeable. The nodules show up as “hot nodules” on the scintigraphy, which means that they absorb a lot of radioactively marked material.

Basedow’s disease: It usually affects younger people, the thyroid gland can be only slightly bigger, but it can also be bigger, and there are usually no nodules. Graves’ disease can be seen in the eyes. Blood will likely have a lot of antibodies to the thyroid. The ultrasound shows that the thyroid is hypoechoic, which means it is quite dark. The scintigraphy shows that the radioactive substance is being taken up all over the body, which is a lot more than normal.[5]

Most of the time, people with an overactive thyroid have to take medicine.

Most of the time, people with an overactive thyroid have to take medicine.

Therapy: What can be done about a thyroid gland that works too much?

Basedow’s disease can sometimes get better on its own. People with hyperthyroidism should take medicine until their symptoms go away. But about half of people with Graves’ disease will get sick again. Then, other types of therapy are used, such as surgery or treatment with radioactive iodine (radioiodine therapy).

Antithyroid drugs, which stop the thyroid from working, can also ease the symptoms of autonomy. But this kind of therapy doesn’t get rid of the autonomous regions. That’s why drugs are usually only used to bridge the time until an operation or radioiodine therapy.

Take thyroid blockers as prescribed.

Most of the time, the first step in treating hyperthyroidism is to take antithyroid drugs, also called “thyroid blockers.” Carbimazole, methimazole, and propylthiouracil are all active ingredients that are often used. If the hormone level in the blood has returned to normal after taking the medicine, radioiodine therapy or surgery may be used to finish the healing process. Thyroid hormones can’t be made when you take antithyroid drugs. But at first, there is still too much of it, so it takes about a week for the person to feel better. Medication isn’t always enough to keep serious hyperfunctions from getting worse. Then, the surgery or radioiodine therapy is done early, even before the hormones have returned to normal, even though the hyperfunction is still there.

In the beginning, antithyroid drugs are given to people with Basedow’s disease for about a year. After this time period, the disease gets better in about half of the cases. The rest of the patients must be cared for in other ways.

During pregnancy, which can make hyperthyroidism worse, antithyroid drugs are the best way to treat it. As low a dose as possible must be used.

Young girl

Problems with the thyroid in pregnant women

The thyroid gland has to do a lot during pregnancy. If the organ can’t make enough hormones, there is a chance that the baby will have problems growing up.

Beta blockers, which are usually used to lower blood pressure, can also be helpful in some situations. The stress hormones adrenaline and noradrenaline are less powerful in the body when these drugs are taken. They slow down the heartbeat and can help people with hyperthyroidism who shake less.

Therapy with radioiodine

The idea: Tissues can be killed by radioactive radiation. The patient is given some radioactive iodine. When hormone metabolism speeds up, thyroid cells are killed. Because more and more of these cells take in radioactive iodine. All cells are hurt by Graves’ disease. During autonomy, radioiodine is mostly used to get to the diseased nodules of the thyroid.

Since those with benign thyroid diseases also release radioactive iodine during treatment, they are kept apart in special hospital departments for three days, or in rare cases for up to five days. This procedure is usually done on adults whose thyroid glands are not too big.

The chance of success is high, but the effects don’t happen right away. And: Hypothyroidism is often a side effect that can happen years after the treatment. But thyroid hormones in tablet form can be used to treat this side effect of the therapy. But people have to take these drugs for the rest of their lives.


When the enlarged thyroid presses on the trachea or when many nodules that make more hormones have been found, surgery may be considered. Even if a malignant tumor is thought to be the cause, surgery is done to remove or shrink the thyroid gland. Thyroid surgery is also in the foreground if a normal thyroid function needs to be restored quickly and can’t be done with medication. The level of thyroid hormone drops right away after the procedure.[6]

There is a chance that the nerve of the vocal cords could be hurt during the surgery, or that the parathyroid gland, which is important for calcium metabolism, could be damaged. But if the thyroid surgeon is very experienced, the risk of problems during the surgery is very low—less than one percent. A cut must also be made in the neck, which will leave a scar. For treatment to work well with few or no side effects, it is important to go to a specialized thyroid center or see a highly specialized thyroid surgeon.

In general, you need to take thyroid hormones and iodide after surgery. This keeps the thyroid from not working right and keeps the remaining thyroid tissue from growing back out of control.

Dry eyes can be helped by artificial tears.

Dry eyes can be helped by artificial tears.

RYF, Stockbyte, and Platinum

Treatment of eye problems in Basel

Graves’ disease can cause problems with the eyes. In order to treat these problems, the thyroid function needs to be brought back to normal.

Goggles that block out light or drops from the pharmacy that act like tears can help with the symptoms of photophobia and dry eyes. When people see double, prism glasses can be helpful.

Glucocorticoid preparations (“cortisone”) and/or irradiation of the tissue in the orbit can also stop the inflammation in the eye in its early stages. If the swollen, inflamed tissue puts so much pressure on the optic nerve that it is in danger, an operation may be needed to relieve the pressure. Surgery can also help with double vision or changes to the eyes that look bad (e.g. strongly retracted eyelids). Stopping smoking is also a must if you want therapy to work.

The treatment of hyperthyroidism, especially the eye symptoms of Graves’ disease (endocrine orbitopathy), must be done in specialized centers and requires good cooperation between doctors from different fields.

Fish should be on the menu all the time.

Fish should be on the menu all the time.

To avoid getting a goiter, which is an enlarged thyroid gland, it is important to make sure there is enough iodine. Iodine is very important for the health of pregnant women, women who are breastfeeding, and young people. The German Society for Nutrition says that pregnant women should get 230 g per day, breastfeeding women should get 260 g per day, teens and adults should get 200 g per day, and people over 51 should get 180 g per day. Iodine is found in high amounts in saltwater fish, for example. They should be on the menu at least once a week because of this.

If someone in your family has already had thyroid disease, it may make sense to have your doctor check your thyroid gland regularly.

Dr. Petra Maria Schumm Draeger is a professor of medicine.

Dr. Petra Maria Schumm Draeger is a professor of medicine.

Hypothyroidism: Signs and How to Fix It

When the thyroid gland doesn’t work as well as it should (hypothyroidism), the body doesn’t have enough thyroid hormones. Details on causes, symptoms, diagnosis, and treatment

Petra-Maria Schumm-Draeger is a professor of internal medicine and an endocrinologist. In 1989, she got her doctorate in “Internal Medicine.” In 1995, the Minister for Science and Art of the State of Hesse gave her the title “extraordinary professor.” From 2002 to 2016, she was the head doctor at the Bogenhausen Clinic for endocrinology, diabetology, and angiology (Munich Municipal Clinic). She has been the Medical Director of the Center for Internal Medicine at the Five Hofe in Munich since July 1, 2016.

Important note:

This article only gives general information, so you shouldn’t use it to diagnose or treat yourself. He can’t take the place of going to the doctor. Our experts are not able to answer each question individually, which is too bad.

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Learn more The Hypothyroidism Solution

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Frequently Asked Questions about Treatments for Hyperthyroidism

What are the common treatments for hyperthyroidism?

The common treatments for hyperthyroidism include antithyroid medications, radioactive iodine therapy, and surgery.

How do antithyroid medications work in treating hyperthyroidism?

Antithyroid medications work by reducing the production of thyroid hormones in the body.

What is radioactive iodine therapy and how is it used to treat hyperthyroidism?

Radioactive iodine therapy involves the administration of radioactive iodine to destroy the overactive thyroid cells. It is commonly used to treat hyperthyroidism.

When is surgery recommended for hyperthyroidism?

Surgery is recommended for hyperthyroidism when other treatment options have not been effective or when there are large goiters present that are causing issues.

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